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Crime Stoppers School Related & Bullying
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Type of Bullying?
School
Online / Cyber
Other
Please Choose Type of Bullying
School/Campus Name
City, State
Where did this happen?
After School Activity
Bus Stop
During Recess
In Class
Front of Building
In the Bathroom
In the Cafeteria
In the Gym
In the Hallway
In the Locker Room
In the Parking Lot
Over the Phone
On the Bus
On the Field
In a Text Message
In an Email
In an Instant Message
Facebook
Instagram
Snapchat
Twitter
Please choose Where
Other place than listed where this happened
When did this happen? (Date/Time)
How are you aware of this incident?
I observed it happen
It happened to me directly
A student told me about it
A co-worked told me about it
I heard a conversation inadvertently
Please choose One Option
How many times did this happen?
Number of people involved?
Name
Grade
K
1
2
3
4
5
6
7
8
9
10
11
12
Please choose Grade Level
Involvement?
Bully
Victim
Bystander
Please choose Involvement
Name
Grade
K
1
2
3
4
5
6
7
8
9
10
11
12
Please choose Grade Level
Involvement?
Bully
Victim
Bystander
Please choose Involvement
Additional Names, Grades, and Involvement
Describe what happened. Give as much detail as possible.
URL (if applicable)
If you have any additional information (pictures, video, audio), please email crimestoppers@iowacounty.org directly
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