Bullying Alert

The form below is provided for you to inform an adult about any situation you are having or know about involving bullying or harassment in school, out of school or online. Please provide as much information as you can so that the problem can be addressed. You may provide this information anonymously.

Today's Date (mm/dd/yyyy)

Names of the people involved and their role in the incident (Witness or Participant). Include the person's grade and school, if known. Example response: John Doe-Participant-Grade 7-Days Park School

Have you told an adult about this incident?
YesNo

The following questions are optional. Answer only if you feel comfortable in sharing this information. All information will be held in the strictest confidence.

IT IS AGAINST THE LAW TO MAKE FALSE REPORTS
Section 240.50 of the New York State Penal Law states: A person is guilty of falsely reporting an incident when, knowing the information reported, conveyed or circulated to be false or baseless, he/she initiates a false report or warning of an alleged occurrence or impending occurrence of a crime, catastrophe or emergency under circumstances in which it is not unlikely that public alarm or inconvenience will result. This is a Class A Misdemeanor.

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