Bullying Report Form Have your reported this incident to anyone in authority?*YesNoThis would include a teacher, principal, or staff member at school.Name of the person allegedly being bullied.*Please put the first name and last name if known.Location of the alleged incident* At School On a Bus Athletic Event Other If Location of the alleged incident is "Other", explain*Date of alleged incident* Date Format: MM slash DD slash YYYY Name of alleged bullyThe alleged bully is a:*StudentSchool EmployeeYour Name (optional) First Last I am a* Student School Employee Parent / Guardian Person Being Bullied Concerned Citizen Friend Other If you answered "Other" above, please explain*What happened?* Physical: Hitting, kicking, or other physical aggression Verbal: Teasing, name-calling, put-downs, or other behavior that would hurt others'feelings or make them feel bad Exclusion: starting rumors, telling others not to be friends with someone, or other actions that would cause someone to be without friends. CyberBullying: Using a computer, cell phone, or other electronic device to engage in any previously mentioned bullying. Other Please check all that applyIf you answered "Other" to the question above, please explain*Description of the event*Please be as specific as possible and include location, date, and time of the alleged incident.Did you witness the event?*YesNoIf you did not witness the event, how were you made aware of what happened?*Please list other students/staff who witnessed the event.Additional CommentsEmailThis field is for validation purposes and should be left unchanged. This iframe contains the logic required to handle Ajax powered Gravity Forms.