Ranch Academy

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Report Bullying

Please complete this form to the best of your knowledge so we can assist you. This information will be kept confidential with the campus administrator and superintendent. We will address this incident within 3 business days.

Please Fill Out The Report Bullying Below

Date of Incident:

Date of Report:

Who was the person(s) engaged in bullying?

Grade of person(s) who engaged in bullying?

Who was being bullied?

Grade of person who was being bullied?

What type of bullying?

Physical

Emotional/Social

Damage to Property

Online

Other

Other location details: (Please explain the specific location details such as which hallway, where on the Internet, what restroom, etc)

Describe what happened with as many details as possible.

Person reporting the incident:(OPTIONAL). Please use your full name.

May we contact you for more information on this incident?

Reaquired field: Yes

Reaquired field: No

Thank you for reporting this incident. We appreciate your concern. When you click "Submit Form" this will be sent to the campus administrator.

Email a copy to

optional

Required Fields