EmailMeForm
CHS Confidential Bullying Report
This report will be submitted to a Crawfordsville Community School Corporation administrator and will be kept confidential. Fields marked with an asterisk * are required.
Please fill out the form with the most accurate and complete information.
Name of Reporter
*
Your name will be kept confidential.
You are the
*
Target - (Being Bullied)
Reporter - (Not the Target)
You are a(n)
*
Student
Staff Member
Parent
Administrator
Other
Reporter Phone #
###
-
###
-
####
Reporter Email
Please include an email address
Incident Information
Name of Target(s)
*
Student(s) Exhibiting Bullying Behavior
*
Date and Time of Incident
*
Location of Incident
*
Incident Description
*
Please describe the incident with details including names of persons involved, what occured, and who did what. Please include specific language used and actions taken.
Witnesses
(People who saw or may have seen the incident or who may have relevant information.)
Name
First
Last
Name
First
Last
Name
First
Last
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