Login

Report Bullying

We are here to help!

 

If you, or someone you know, is being bullied, please fill out the form below. Your report will be sent directly to your school’s safety officer. Your identity will be kept strictly confidential, and will not be disclosed to the individual or individuals who are doing the bullying.


If you would like more information about what constitutes bullying, click here.


Note : Fields marked with an asterisk are mandatory


Note : If you wish to remain anonymous, check the box below:
Your Name : First*     Middle      Last*  
Home Address: Number & Street*
City*   State*   ZIP/Postal Code* 
Home Phone :       Cell Phone :   
Your Email Address :  

Please indicate:*  

Please Indicate:

      Name of individual or individuals who are doing the bullying

      First Last Add Another
Please Indicate:

   

Please identify the type of bullying that is occurring (check all that apply):


Please describe the bullying behavior in detail:
How stressed out, worried, depressed or frightened are you by this bullying?
Have you discussed this bullying with your parents?

Additional Comments:
Please indicate how you would like us to contact you:
         
Would you like to have a copy of this report sent to your email address?