Lake Harriet Bully Box Reporting Form

Use this form to report issues relating to racism, bullying, cyber-bullying, and harassment. Bullying is when one or more people repeatedly harm, harass, intimidate, or exclude others. Bullying is unfair and one-sided. Bullying includes both direct (e.g., 
physical aggression, verbal abuse) and indirect (e.g., gossip, nasty looks, texting) forms.

This form will be read by the appropriate school personnel, who will research your report and respond as necessary. We will take all reports seriously. There will be a consequence for any reports that are not serious in nature.

 

 

Your Name 
Submitting your name is optional, but helpful. Please understand, without providing your contact information it may be difficult to pursue this report.
Describe what happened.
Bully 
Victim 
Witnesses/bystanders 
What happened 
Location 
Date and Time this happened 
What sort of help would you like with this issue?  
Have you told anyone else about this incident? Who?  
Additional information