Report Bullying - Crossroads Christian School

Person reporting *

* (1 required)

Student Parent/Guardian Staff Other:

Other:

Phone Number *

Alleged Victim: *

Is the alleged victim a student? * (1 required)

yes no

School of victim

Alleged Bully: *

Is alleged bully a student? * (1 required)

yes no

School of bully:

Possible Witness(es): *

Date of Incident *

Location of Incident *

Describe incident(s) in as much detail as possible *

Why do you think the bullying happened? *

Please attach any pictures or video you may have:

(allowed file types: avi, doc, docx, gif, html, jpeg, jpg, m3u, m4a, m4v, mov, mp3, mp4, mpeg, png, wma, wmv)