Center Point ISD - Report Bullying

Report Bullying

Please complete this form to the best of your knowledge so we can assist you.
This information will be kept confidential with your campus administrator and/or superintendent.

Bullying Report

Date of Incident:

Date of Report:

Who was the person(s) engaged in bullying?

Grade of person(s) who engaged in bullying?

Who was being bullied?

Grade of person who was being bullied?

What type of bullying?

Physical

Emotional/Social

Damage to Property

Online

Other:

Other location details: (Please explain the specific location details such as which hallway, where on the Internet, what restroom, etc)

Describe what happened with as many details as possible.

May we contact you for more information on this incident? Enter contact information in following boxes. Please understand, we may not be able to resolve the situation without your contact information.

Yes

Person reporting the incident: Enter your Full Name so we are able to followup. Complete this box if you selected "Yes" above. Enter NA if you selected "No" above and do not want us to know.

Email Address so we are able to follow-up. Please enter your email address if you selected "Yes" above.

Phone Number so we are able to follow-up. Please enter your phone number if you selected "Yes" above.

Thank you for reporting this incident. We appreciate your concern. When you click "Submit Form" this will be sent to the campus administrator.

Email a copy to

optional

Required Fields