Beeville ISD - R.A. Hall Elementary School - REPORT A BULLYING INCIDENT

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RA HALL ELEMENTARY

Please complete this form to the best of your knowledge so we can assist you. Add as much information as you can including the date, time and location of the incident. Be sure to include what school you are associated with.

RA Hall Elementary Bullying Incident Report

Date of Alleged Incident:

Date of Report:

Who was the person(s) allegedly engaged in bullying?

Grade of person(s) who allegedly engaged in bullying?

Who was being bullied?

Grade of person who was being bullied?

What type of bullying?

Reaquired field: Physical

Reaquired field: Emotional/Social

Reaquired field: Damage to Property

Reaquired field: Online

Reaquired field: Other

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.

Person reporting the incident:(OPTIONAL). Please use your full name.

May we contact you for more information on this incident?

Yes

Click SEND to SUBMIT.

Thank you for being part of the solution and reporting the incident. We appreciate your concern. When you click SUBMIT this form will be sent to an administrator.

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