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We are in the process of including the bullying report form online in Spanish and Vietnamese. In the meantime, you can find bullying report forms in Spanish and Vietnamese at your school office or at the District office.

Estamos en el proceso de subir a Internet el formulario para informar actos de bullying (abuso o acoso) en español y vietnamita. Mientras tanto, puede encontrar estos formularios en dichos idiomas en la oficina de su escuela o en la oficina del Distrito.

Chúng tôi đang trong quá trình đưa lên mạng (trực tuyến) mẫu báo cáo hành vi bắt nạt bằng tiếng Tây Ban Nha và tiếng Việt. Trong khi chờ đợi, quý vị có thể tìm thấy các mẫu báo cáo hành vi bắt nạt bằng tiếng Tây Ban Nha và tiếng Việt tại văn phòng nhà trường hoặc tại văn phòng Học Khu.

Bullying Report Form

Instructions:

Bullying is serious and will not be tolerated. This is a form to report alleged bullying that occurred on school property, at a school-sponsored event off school property, on a school bus, on the way to and/or from school, or on an electronic device.

If you are a student, parent/guardian, close relative, teacher, or other staff member and wish to report an incident of alleged bullying, complete the entire form and respond only to questions that you feel comfortable answering and are able to accurately answer.

You may choose to include your name on the form or you may submit it anonymously. Please note that the district’s ability to investigate an anonymous complaint may be limited and the district prohibits retaliation against anyone who files a bullying report.

You can choose to fill-out and submit this form online or print the form out and return it to your site principal or the district office. Please contact the school or district office if you require additional information or assistance.

 

Click here to download and print the Bullying Report Form

 

Click here to download and print the Bullying Report Form

-Please be sure to save and open the file with Adobe Reader in order to be able to fill it out online prior to printing.

Reporter Information

Incident Information

If you don't know names, please describe him/her/them​
If you don't know the alleged bully's name, please describe him/her/them​​​
first and last name and grade, if known. If you don't know the victim's name, please describe him/her/them​​
(i.e., letters, texts, photos, etc.)​​​​
Max file size: 10 MB
(i.e., letters, texts, photos, etc.)​​​​​
Max file size: 10 MB
(i.e., letters, texts, photos, etc.)​​​​
Max file size: 10 MB

Evergreen School District

  • 3188 Quimby Road
  • |
  • San Jose, CA 95148
  • |
  • Phone: 408-270-6800
  • |
  • Fax: 408-274-3894
  • |
  • info@eesd.org
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