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Safe To Say- Report Bullying or Suicide Prevention

Complete this form to report a bullying incident or for suicide prevention. You do not have to include your name if you wish to remain anonymous. The campus principal and superintendent will be notified once this form has been submitted. False reporting by students will result in disciplinary action. If you are experiencing a problem that needs immediate attention, tell a teacher, school leader, or other trusted adult as soon as possible. If this is an emergency, call 911.

Situation*

Answer Required

I think I was bullied.

I was a witness to what I think was bullying.

I was informed of possible bullying.

I am having or had thoughts of hurting myself.

I heard of someone having thoughts of hurting themself.

Other:

When did the possible bullying or harmful thoughts occur?*

Answer Required

Where did the possible bullying or harmful thoughts occur?*

Answer Required

Name of the student possibly being bullied or thinking of harming themself.

Answer Required

What happened or what did you hear? (Please provide specific details including name(s), bus number, bus driver name, campus, classroom etc. if available)*

Answer Required

Your Name

Answer Required

Your Email

Answer Required

Your Phone Number

Answer Required

Disclaimer*

Answer Required

I declare that this report is true to the best of my knowledge and belief, and I understand the content will be used to assist students in need.