Vermillion Elementary School Bullying Incident Report
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Bullying Incident Report Form
1.
Name of student target (victim)
*
Enter at least 1 response and no more than 3 responses.
First Name
M.I.
Last Name
2.
Where does he/she attend school?
*
--Please Select--
Complete High School Maize
Maize High School
Maize South High
Maize Middle School
Maize South Middle School
Maize Central Elementary
Maize Elementary School
Maize South Elementary
Pray-Woodman Elementary
Vermillion Elementary
Maize Early Childhood Center
3.
Has the appropriate teacher/coach/bus driver been contacted?
Has the appropriate teacher/coach/bus driver been contacted?
Yes
No
4.
If Yes, please provide the name(s) of who you contacted:
5.
Name(s) of alleged bully(ies) (if known):