Student Bullying, Harassment, Intimidation

The Washington Elementary School District provides an online form to report instances of student bullying, harassment, and/or intimidation. Please verify your email address below to continue to the form.

When you submit the form, administrators at the selected school will be emailed. If you feel you are in immediate danger, please call 911.

Ver este formulario en español. (View this form in Spanish)

Fields marked with an asterisk (*) are required.

Your Information

I am a:*

My grade is:*

First Name:*

Last Name:*

Email:*

Phone #:

Incident Information

School where the incident(s) happened:*

Date of Incident(s):*

Victim Name(s):*

Offender Name(s):*

Witness Name(s):

Where did the incident(s) happen? *

Select all that apply.

Bus

Cafeteria

Classroom

Hallway

Playground

Restroom

School Activity / Event

To / From School

Other: Please specify other location

What best describes what happened? *

Select all that apply.

Cyberbullying

Hitting

Inappropriate Touching

Intimidation

Kicking

Name Calling

Profanity

Pushing

Rude / Threatening Gestures

Rumors / Gossip

Social Exclusion / Rejection

Teasing

Theft

Threatening

Other: Please specify other incident type

Detailed description of what you saw and heard:*

Please list anyone who can provide more information regarding this complaint:

Witness 1

Name

Grade

Teacher

Witness 2

Name

Grade

Teacher

Witness 3

Name

Grade

Teacher

Upload Photo / Screenshot:

Accepted file types: JPG, PNG, or GIF. Maximum file size: 10MB

Resolution

What do you think can and should be done to solve this problem?*

Submit Report

I certify that the information provided in this report is correct and true to the best of my knowledge.*