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Reporting A Bully Form

Please complete the form below to the best of your ability.  All questions with an * asterik must be answered before the submission in order to be able to address the problem; the victim and the bully must be identified.

This information is addressed by the administrators of the district and is strictly confidential.

Please indicate where the incident took place.*
Answer Required
Do you know the main bully?*
Answer Required
Do you know the second bully?
Answer Required
Do you know the victim?*
Answer Required
Gender of the bully?*
Answer Required
Gender of the second bully?
Answer Required
Gender of the victim?*
Answer Required
Grade of the bully?*
Answer Required
Grade of second bully?
Answer Required
Grade of the victim?*
Answer Required
Have you told any teacher, school administrator, parent or other adult about this incident?*
Answer Required

The reporters personal information is OPTIONAL and appreciated.  

Your grade?
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You may upload any files related to the incident.
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or drag it here.
Confirmation Email
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The Orange Grove I.S.D. and its Career and Technology Education Program do not discriminate on the basis of sex, disability, race, color, or national origin in its educational programs, activities, or employment as required by Title IX, Section 504 and Title VI.