Bullying Report Form JICDE*-E-1

Required

Instructions: Bullying is reportable in person or in writing to school staff. This form is to be completed by the bullying target, witness, or any person with information about an incident of bullying. This form is received by the Superintendent, Director of Student Services, and the school principals.
Must contain a date in MM/DD/YYYY format
Name of person making the report (optional):
First Name
Last Name
Person making the report is:requiredPlease select up to 1 choice
Please select up to 1 choice
Do you prefer to remain anonymous?required
Are you the target of the alleged bullying?required
Was there a real or perceived imbalance of power?required
Attach up to 3 files with a maximum size of 10MB
No file chosen
By typing your name below and selecting “I consent”, I am signing this agreement electronically, and I agree that my electronic signature is the legal equivalent of my manual signature on these agreements. I specifically agree that any electronic signatures that I provide through this online process are valid and enforceable as my legal signature. I acknowledge that these electronic signatures will legally bind me to the terms and conditions contained in the related documents just as if I had physically signed the same documents with a pen.required
By completing and signing this form, I attest that the information provided, including any attached incident-related evidence, is true and accurate to the best of my knowledge.