Version en español
PERSON REPORTING INCIDENT:
STUDENT VICTIM:
*On what date did the incident happen?
(mm/dd/yyyy)
Date format is incorrect.
Incident date is a required field.
Incident date can not be beyond today's date.
Alleged Witness(es) (if known):
Alleged Offenders: (Please enter 'Unknown' in Last Name field if you don't know the offender's name)
*Where did the incident happen (choose all that apply)?
Please select at least one location.
*Check the boxes that best describe what happened (choose all that apply):
Please select at least one description. You may provide details in the spaces below.
Please specify the detail of what happened.
Please specify the detail of what happened.
Please specify the detail of what happened.
*What did the alleged offender(s) say or do?
What did the alleged offender(s) say or do? is a required field.
Character entered exceed the limit of 1000
*Why did the harassment or initimidation (bullying) occur?
Why did the harassment or initimidation (bullying) occur? is a required field.
Character entered exceed the limit of 1000
*Did a physical injury result from this incident? Please select one of the following:
Did a physical injury result from this incident? is a required field.
*If there was a physical injury, do you think there will be permanent effects?
There should not be a permanent effect if no physical injury exists.
*Was the student victim absent from school as a result of the incident?
Please check if student victim absent from school.
*If yes, how many days was the student victim absent from school as a result of the incident?
Days absent is required.
If the victim was absent, please select ‘Yes’ for the previous question
*Did a psychological injury result from this incident? Please select one of the following:
Did a psychological injury result? is a required field.
Is there any additional information you would like to provide?
Character entered exceed the limit of 1000
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