Bullying Incident Report

 
Page 1 of 1
 
 Bullying Incident Report 
Please use this form to report any bullying incident that you have been victim to or witnessed.

YOU ARE ENCOURAGED TO CONTACT THE SCHOOL OF THE STUDENTS INVOLVED IN CASE OF AN EMERGENCY.

High School: 716-807-3600
Middle School: 716-807-3700
Intermediate School: 716-807-3825
Drake Elementary: 716-807-3725
Ohio Elementary: 716-807-3800
Spruce Elementary: 716-807-3850

PLEASE NOTE: False reporting of an incident is against state law and school policy 7311. Section 240.50 of the New York State Penal Law states: A person is guilty of falsely reporting an incident when, knowing the information reported, conveyed or circulated to be false or baseless, he/she initiates a false report or warning of an alleged occurrence or impending occurrence of a crime, catastrophe or emergency under circumstances in which it is not unlikely that public alarm or inconvenience will result. This is a Class A Misdemeanor.

 
1.
*
  Select Date
mm/dd/yyyy
   
2.
*
  Select Date
mm/dd/yyyy
   
3.
*
 
  
  

    
   
4.
*
 
  
  
  
  
  
  
  

    
   
5.
*
 
   
6.
*
 
    
Person 1   
Person 2   
Person 3   
Person 4   
Person 5   
Person 6   
Person 7   
Person 8   
   
7.
*
 
   
8.
 
   
9.
*
 
   
10.
 
   
11.
 
   
12.
 
   
 
 
 
 Done  Save  Cancel