"*" indicates required fields Campus*- choose one -East Campus (PK-6th Grade)West Campus (7th-12th Grade)Your Name:Leaving your name makes this report identifiable. We will still treat your information as confidential but the school counselor or administrator may connect with you regarding this report. If you do not leave your name, we will observe and investigate to the best of our ability. If you feel like this needs a more urgent response or intervention please reach out to the school counselor, principal or Head of School. Individuals involved?* Please describe what happened:*Where did the incident occur?* Please list the names of any witnesses that saw the incident take place How often has the bullying occurred? How have you responded to the bullying? Who have you spoken to about the incident? Who do you want to be notified of this incident?* What would you like the response to be?* I just want someone to be aware. I want an adult to talk to the individual(s) bullying me. I want an adult to help solve the problem. I want an adult to try to stop the bullying without identifying myself or the bully. Other
