The Century Middle School Staff want all students to feel safe at school. If you or someone you know is being bullied or harassed at school, please let us know.  Complete the form below.  Even though you must provide your name and email address, your information will remain confidential.

This site will be monitored during school hours. If you have an emergency after school hours, please call 911 or SAFE2TELL at 1-877542-SAFE.<form method="post" action="http://www.emailmeform.com/fid.php?formid=172852" enctype="multipart/form-data" accept-charset="UTF-8">
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<font face="Verdana" size="2" color="#000000">Bully Button Submission</font>
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 <td nowrap><font face="Verdana" size="2" color="#000000">What is YOUR Name (first and last required)?</font></td>
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 <td nowrap><font face="Verdana" size="2" color="#000000">What is YOUR email address?</font></td>
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 <td nowrap><font face="Verdana" size="2" color="#000000">Who is being bullied?</font></td>
 <td><textarea name="FieldData2" cols="60" rows="10"></textarea><br> </td>
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 <td nowrap><font face="Verdana" size="2" color="#000000">Who is doing the bullying?</font></td>
 <td><textarea name="FieldData3" cols="60" rows="10"></textarea><br> </td>
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 <td nowrap><font face="Verdana" size="2" color="#000000">Where does the bullying/harassment take place?</font></td>
 <td><textarea name="FieldData4" cols="60" rows="10"></textarea><br> </td>
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 <td nowrap><font face="Verdana" size="2" color="#000000">When is the bullying/harassment taking place?</font></td>
 <td><textarea name="FieldData5" cols="60" rows="10"></textarea><br> </td>
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 <td nowrap><font face="Verdana" size="2" color="#000000">Is there any other information we may need?</font></td>
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<td class="label" colspan="2"><font color="#FFFFFF" face="Verdana" size="2"><b>Image Verification</b></font></td>
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<td class="captcha" style="padding: 2px;" width="10"><img src="http://www.emailmeform.com/turing.php" id="captcha" alt="captcha"></td>
<td class="field" valign="top"><div><font color="#000000">Please enter the text from the image</font>:<br><input type="text" name="Turing" value="" maxlength="100" size="10">
 [ <a href="#" onclick=" document.getElementById('captcha').src = document.getElementById('captcha').src + '?' + (new Date()).getMilliseconds()">Refresh Image</a> ] [ <a href="http://www.emailmeform.com/?v=turing&amp;pt=popup" onClick="window.open('http://www.emailmeform.com/?v=turing&amp;pt=popup','_blank','width=400, height=500, left=' + (screen.width-450) + ', top=100');return false;">What's This?</a> ]</div>
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<input type="text" name="hida2" value="" maxlength="100" size="3" style="display : none;">
<input type="submit" class="btn" value="Send email" name="Submit">&nbsp; &nbsp; <input type="reset" class="btn" value="  Clear  " name="Clear"></td>
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