Name(s) of student(s) believed to have been bullied? *Required

Student believed to have been bullied attends which school? *Required
CHRHS CRMS CRES

Name(s) of student(s) alleged to have bullied? *Required

Name(s) of potential witnesses:

Relationship between alleged students:

Location of alleged incident(s): *Required

Description of incident(s). Be as specific as possible: *Required

Is this a first-time occurrence? *Required
Yes No

What occurred previously?

This report is based on the following evidence (pick as many as apply)
I have witnessed the bullying myself
I have digital evidence of the bullying
The student who was bullied reported it to me
I heard about it from someone else or overheard people talking about it

Do you have a photo?

I certify that the information on this form is accurate and true to the best of my knowledge and belief.