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Report Bullying
Bullying Incident Report

If your having trouble submitting this form please contact the LCS Bullying Prevention Coordinator/Dignity Act Coordinator: Mr. Hoover (315)658-2241 ext 11

What is your name and how can we contact you? (Providing this information is optional)
Are you the person being teased or harassed in any way?
If you're not the person being bullied, have you witnessed someone else being bullied?
What is the name of the person being bullied?
What time of day is this happening? (Enter time of day, class period, etc)
Where is this happening? (Be specific: playground, bus, classroon, hallway, etc)
Describe what is happening in the best way that you can.
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