Anonymous HIB Reporting
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Anonymous HIB Reporting
Please complete all sections of this form. It will be submitted to the building principal via e-mail. Please note that formal disciplinary action may not be taken solely on the basis of an anonymous report.
1.
Today's date
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mm/dd/yyyy
2.
Alleged Target(s)
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3.
Alleged Actor(s) of HIB behavior
*
4.
Date of Alleged Incident (mm/dd/yyyy)
*
mm/dd/yyyy
5.
School
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--Please Select--
Mahwah High School
Ramapo Ridge Middle School
Joyce Kilmer School
Lenape Meadows School
George Washington School
Betsy Ross School
6.
Select the alleged category of Harassment, Intimidation, and Bullying
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Race
Color
Religion
Ancestory
Origin
Gender
Sexual Orientation
Gender Identity & Expression
Mental, physical, or sensory disability
Other distinguishing characteristic
7.
Describe the nature of alleged harassment, intimidation, or bullying. Include and gesture, any relevant written, verbal, or physical act(s), or any electronic communication.
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8.
Location of alleged HIB incident
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--Please Select--
School property
School sponsored event
School bus
Off school grounds
9.
Witnesses: List below any person who you know or have reason to believe may have relevant information and indicate if the witness is a student, parent, staff member, or other.
*