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Student harassment report form

This form is to be used to report any type of harassment that a student feels he or she has experienced.

2 minutes to complete

Eligibility

All the regular students are eligible to fill out the form.

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Questions for Student harassment report form

Questions

1.

What is the name of the student who is being harassed?

The answer should be a text input.
2.

What is the name of the student who is harassing?

The answer should be a text input.
3.

What is the nature of the harassment? (e.g., physical, verbal, online, etc.)

The answer should be a text input.
4.

When did the harassment take place?

The answer should be a date input.
5.

Where did the harassment take place?

The answer should be a text input.
6.

Have you witnessed the harassment yourself?

The answer should be a text input.
7.

Have you spoken to the student who is being harassed?

The answer should be a single choice:
  1. Yes
  2. No
8.

Have you spoken to the student who is harassing?

The answer should be a single choice:
  1. Yes
  2. No
9.

Has the student who is being harassed filed a formal complaint?

The answer should be a single choice:
  1. Yes
  2. No
10.

Has the student who is doing the harassment been disciplined in any way?

The answer should be a single choice:
  1. Yes
  2. No
11.

Do you have any other information about the incident that you would like to share?

The answer should be a text input.

Forms Similar to Student harassment report form

  • Anti-Bullying and Harassment Report Form
  • Sexual Harassment Report Form
  • Student Discrimination and Harassment Complaint Form
  • Student Code of Conduct Violation Report Form

Here are some FAQs and additional information
on Student harassment report form

How do I fill out the student harassment report form?

To fill out the form, please provide the following information: -The name of the student who was harassed -The name of the student who committed the act of harassment -The date and location of the incident -A description of the incident

Who should I submit the form to?

Please submit the form to your administration.

What happens after I submit the form?

After you submit the form, the administration will investigate the incident and take appropriate disciplinary action.

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