JRMS Bully Form
Submitted by (your name or anonymous):
Email Address (optional):
Who is making the report (parent or guardian, teacher, student, or other)?
The student being reported as committing the bullying:
The student that was bullied:
Date, Time, and Place of the bullying:
Description of the bullying incidents(s):
Name of witnesses:
Any addition information that you think will help us understand this incident:
form mail