Bullying Reporting Form
Student Bully Reporting Form
This form is to help students report bullying issues on Travis Education Center's campus. Students can use this form to report any concerns they are having about themselves or ones they have witnessed.
What date did the bullying occur?
what type of bullying are you experiencing?
Select at least 1 and no more than 3.
Name and Grade of VICTIM
Name(s) of BULLY (If more than one bully, include all names)
WHEN and WHERE did the incident occur? (Be specific; if the incident is from cyber-bullying, please state website/app and usernames of the people involved)
In your words, describe what happened.
Are there any witnesses to the incident? If so who?
Your Name and Grade (optional)