Anonymous Bullying/Harassment Report
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Anonymous Bullying/Harassment Report **CONFIDENTIAL**
Name (Optional)
First
Last
Contact Information (Optional)
Phone
E-mail
Name of person being bullied.
*
Describe what happened when you were bullied, or when you witnessed someone else being bullied.
Location of incident:
*
Currituck County High School
J.P. Knapp Early College
Currituck County Middle School
Moyock Middle School
Moyock Elementary School
Shawboro Elementary School
Knotts Island Elementary School
Central Elementary School
W.T. Griggs Elementary School
Jarvisburg Elementary School
Other, please specify
When AND Where did the incident occur?
Were you, or someone else threatened in any way?
What reaction to the situation occurred?
Would you like to speak with your counselor/administrator concerning this situation?
Has this incident been reported before?
Has this incident been reported before?
Yes
No