Longfellow Elementary School-Bullying Report Form English
Sign in to Google to save your progress. Learn more
Date *
MM
/
DD
/
YYYY
To: Principal/Assistant Principal
From (Optional):
OR-Parent's Name
Who is the student/person that is bullying you? *
Give specific examples of how you're being bullied? *
 For example: PHYSICAL: hitting, pushing, kicking, biting...etc...VERBAL: name calling, profanity, made fun of in front of others, starting rumors about you, "cyber-bullying." HOW OFTEN HAS THIS BEHAVIOR OCCURRED?
What would you like to happen? *
Describe the informal efforts you made to correct the situation described. What actions have you taken to solve the situation? *
(Walk away...Ask for help...Speak up for yourself...)
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Riverside Unified School District. Report Abuse
Google Forms