BULLY REPORTING FORM

Please Note: All fields marked with a * must be filled in and be valid in order to submit.


Which campus does this involve?*:
Lincoln-Way Central
Lincoln-Way East
Lincoln-Way West


Name of person allegedly being bullied*:

Name of alleged bully:

Your name: (optional):


I Am A*:
Student
School Employee
Parent/Guardian
Person Being Bullied
Community Member
Other


Type of Event (Select All That Apply)*:
Physical - Hitting, Kicking, Physical Agression
Verbal - Teasing, Name Calling, Put Downs
Emotional - Starting Rumors, Being Excluding
Cyber Bullying - Using an electronic medium to engage in bullying


Please describe the events (Be specific, include date, time, location)*:



Did you witness the event?*:
Yes
No


List any other witnesses to the event:



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