HIB 338 Community Form Harassment, Intimidation or Bullying (HIB) Form

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

This form should be used by parents or guardians to report allegations of HIB. Once the form is received by the school, the principal is responsible for implementing the school district's policy and procedures. Should you have any questions, please contact the principal.

Please select the school that applies to this report *

WTB Walter T Bergen School

SRD Samuel R Donald School

MBD Martha B Day School

Unsure

Individual Completing this Form. (If you prefer to remain anonymous, leave this section blank.) Otherwise, please provide your name and relation to the individual involved in the alleged incident of and a contact phone number and email to reach you.

Please provide the date and approximate time when this incident occurred.

Please describe the incident in as much detail as possible (What was the incident? Who was involved? How were you made aware of the incident? How did the incident occur?)

Specific incident location (i.e., in a specific classroom, specific hallway/location, online/via social media)

Please provide the name of the alleged offender

Please provide the victim name that you are submitted on behalf

Please provide any additional information that you believe is useful in relation to this incident.

Submit

Clear form

Never submit passwords through Google Forms.

This form was created inside of Bloomingdale School District. Report Abuse

Forms