Enter YOUR name, the name of the person filling out the form. You can submit an anonymous form, but there will be no consequence for the aggressor. I strongly recommend entering your name.
The TARGET is the person being bullied. Choose "Target" if YOU are being bullied or harassed.
If you are reporting about someone else being bullied or harassed, you are the "Reporter" and should choose that option.
Enter your telephone number and email address so that the school can get in touch with you. Although optional, I advise you to enter both.
I believe there may be DISABILITY issues involved.
I believe there may be RACE or COLOR issues involved.
I believe there may be SEXUAL ORIENTATION issues involved.
I believe there may be GENDER DISCRIMINATION involved.
I believe there may be RELIGIOUS DISCRIMINATION involved.
I believe there may be AGE DISCRIMINATION involved.
This is where you describe the incident or incidents. Give facts and quotes as necessary. If you need more room, you can add additional pages after printing out this form.
If there was not enough room to enter all the information, you can continue it on a separate sheet of paper or on the back of the form after you print it. Check this box to let the school know that the description is continued.
Do you have other documentation that you believe will be helpful to the school but it is not on this form. It might be pictures, videos, screen shots, emails, etc. If you pick "Attached," you will attached those materials to the form you print out.
This is a test to see that you are a real person! Simply click the box.
By clicking on the "Submit" button, the data will be merged onto the proper form so you can give it to the school district. The form will download to your computer when you hit the Submit button.
Once downloaded, you can open the report in Adobe Reader (or your browser) to edit, view, or print. You can then send the form to the school district.
If you need help after submitting, Contact me.
If you need Adobe Acrobat Reader DC (the odds are you don't), download here