Request edit access
Brooklyn Schools Bullying, Harassment, or Intimidation Form
If you suspect a child you are aware of is being harassed, bullied or intimidated please fill out the below form. Upon  completion of the form, please notify either the Elementary or Middle School depending on where the child attends through phone call or email immediately.  
Sign in to Google to save your progress. Learn more
Email *
Today's Date
MM
/
DD
/
YYYY
Person Reporting the Incident (Please include contact information)
The person reporting this incident is... *
Required
Name of alleged student victim, age and school
Name(s) of alleged witnesses (if known) including age and school
Name(s)of alleged offender(s) (if known) including age and school
Where did the incident happen
Check the statement(s) that best descries what happened (choose all that apply)
Did physical injury result from this incident?
Clear selection
Additional Pertinent Information that you would like the investigator to know
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Brooklyn Public Schools. Report Abuse