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School District of Desoto
Report a Bully Survey
8/22/2019

Instructions: Please complete the following, with as much detail as possible. Click the [Submit] button at the bottom of the page to submit your information. This report will be kept confidential, and your identity will remain anonymous. It will be sent to the Office of the Superintendent, who will forward it to the appropriate school administrator. The principal or principal's designee will handle the investigation.

 

Your name, grade, and school (your name is not required, but would be appreciated):
Name, grade, and school of the target(s):
Name, grade, and school of the bully(ies):
List the events that have happened:
List the dates and times you have been a target of this person (to the best of your ability):
List the place(s) in which this has happened (where?):
List the witness(es):
List anyone to whom you have reported these behaviors:
List the things you have tried to help this situation (if anything):
Verification Code:*
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Enter the letters as they are shown in the image. Letters are not case-sensitive.
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