Please fill in all the information you can to help us stop the bully!  Please try to give us a name or nickname.  Don't worry about the spelling. Spell it like it sounds.  Do the best you can to remember the date and time.  Be sure to identify the school you are from so we can direct your information effectively.  You must answer all questions with a yellow background before you will be able to submit this report.
What Happened
When did this occur? Date: Time:
Where did the incident occur?
Please describe the incident and location (Cafeteria, Hallway, Restroom, Playground, etc)
Your Information (optional)
First Name
Last Name
Email Address

Information about who was there, what role they played, and/or who you talked to about the incident
In this section you will be describing the people that were there when the bullying incident occurred.
You will need to provide at least one bully and one victim in order to submit your report.

If you talked to a school official (teacher, counselor, principal, etc.) about the incident,
you will enter the information in this section.
Click the "Ok" button to begin