Report A Bully
"A Safe Way to Report a Bully"


 

Jefferson Craig Elementary School
Switzerland County School Corporation
1002 West Main Street
Vevay,IN 47043

 

Please fill in all the information you can to help us stop the bully!

Bully's Name:
Main Bully's First Name
Main Bully's Last Name
Please try to give us a name or nickname. Don't worry about the spelling, spell it like it sounds.
Second Bully's Name:
Second Bully's First Name
Second Bully's Last Name
If there was a second Bully or a person helping the Bully put their name on this line.
Victim's Name:
Victim's First Name
Victim's Last Name
You can use any name including nicknames.  Don't worry about the spelling, spell it like it sounds. If it was you then put your name.
Date/Time of Incident:
Date
(Example: 03/25/2013)
Time
(Example: 1:30 pm)
Do the best you can to remember the date and time.  You can click HERE for a calendar.
Do you know these people?:
Tell Us Your Relationship with These People
3
Main Bully
Second Bully
Victim
Location :
Where did the incident happen?
Description
Tell us what the Bully did to the Victim.
Witnesses/ By- Standers:
Please give us the names of witnesses or bystanders who might also have seen this happen besides you.

Other Information That Might Help Us

 
Race:
Bully
Second Bully
Victim
1
Gender:
Bully
Second Bully
Victim
Grade:
Bully
Second Bully
Victim
Your Information is Optional But Appreciated
WE PROMISE TO PROTECT YOU
Your Name:
 
First Name
 
Last Name
2
Contact Info:
 
Phone Number
 
Email Address
Grade:
Your Grade
 
 

 

1st Bully's Name:

2nd Bully's Name: