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(opens in new window/tab)
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(opens in new window/tab)
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In This Section
Bullying Report Form
Bullying Report Form
This form requires Javascript to be enabled for submission and authorization.
*
Required
Name
*
required
First Name
Last Name
When did the bullying happen?
*
required
Must contain a date in M/D/YYYY format
Who do you think was bullied?
*
required
First Name
Last Name
Where does this person attend school?
*
required
Edgewood High School
Edgewood Junior High School
Edgewood Intermediate School
Edgewood Primary School
Edgewood Early Childhood Center
Who is this person's teacher?
First Name
Last Name
Person's Grade?
*
required
Who do you think was bullying?
*
required
First Name
Last Name
Person's Grade?
*
required
Type of Bullying
*
required
Called Mean Names
Excluded (Left Out)
Took of Damaged Something
Threatened
Hit, Kicked, Punched
Told Lies/ Spread Rumors
Cyber-Bullying (Online/eMail/Text, Etc.)
Racial/ Offensive Comments (Talking)
Where did the bullying happen?
*
required
Hallway
Cafeteria
On the Bus
Bus Stop
Classroom
Playground
Bathroom
Going to/from School
Online/eMail/Text
Is this the first time this has happened?
*
required
Yes
No
Who has been told about the bullying or saw that happen?
*
required
Teacher
Principal
Friend
Parent/Guardian
Assistant Principal
Students
Counselor
No One Yet
Have you filed a Student Bullying Report before?
*
required
Yes
No
Any other information you would like to share?
Submit