subject_line
REPORT AN INCIDENT OF BULLYING, HARASSMENT
OR DISCRIMINATION
Today's Date:
*
+
I am a
*
Student
Parent
Faculty Member
Name
(optional, but helpful)
Daytime Phone
(optional)
Address
(optional)
E-Mail
(optional)
Name of the student(s) the incident happened to:
*
Age
*
Grade
*
School:
*
Crowley High School
North Crowley High School
Crowley 9th Grade
North Crowley 9th Grade
H.F. Stevens Middle School
Crowley Middle School
Richard Allie Middle School
Summer Creek Middle School
Crowley Learning Center
Bill R. Johnson CTE Center
Bess Race Elementary School
Sycamore Elementary School
Deer Creek Elementary School
Meadowcreek Elementary School
Jackie Carden Elementary School
June W. Davis Elementary
Parkway Elementary School
Oakmont Elementary School
Dallas Park Elementary School
J.A. Hargrave Elementary School
Sidney H. Poynter Elementary School
Sue Crouch Elementary School
S.H. Crowley Elementary School
David L. Walker Elementary School
Mary Harris Elementary School
Name(s) of the student(s) causing the problem(s):
Age
Grade
School:
*
Crowley High School
North Crowley High School
Crowley 9th Grade
North Crowley 9th Grade
H.F. Stevens Middle School
Crowley Middle School
Summer Creek Middle School
Crowley Learning Center
Bill R. Johnson CTE Center
Bess Race Elementary School
Sycamore Elementary School
Deer Creek Elementary School
Meadowcreek Elementary School
Jackie Carden Elementary School
Parkway Elementary School
Oakmont Elementary School
Dallas Park Elementary School
J.A. Hargrave Elementary School
Richard Allie Middle School
Sidney H. Poynter Elementary School
Sue Crouch Intermediate School
S.H. Crowley Intermediate School
David L. Walker Intermediate School
Mary Harris Intermediate School
Date of Incident
+
Time of Incident
Location of the incident?
*
School
Online
Somewhere other than school
All or some of the above
Where did incident happen
Has this incident been reported to anyone yet?
If so, to whom?
(teacher, parent, etc)
Were there any witnesses?
*
Yes
No
If Yes, please provide their names
(if known)
Describe what happened and how long it has occurred (Please describe in as much detail as possible. Include information on the bully, victim, any witnesses/bystanders, etc. The more detail, the better.)
*
Additional Information
(optional)