If you are reporting an incident of bullying that occured at a bus stop, please provide the location of the bus stop and the bus number, if known.
When reporting cyberbullying, please provide as much information as possible. Include type (Phone text messages, Social Network, Blogs...) For social networks please provide the page owner, if known.
If you are reporting an incident of bullying that occured in a school parking lot, please provide which parking lot and a descriptions of any cars you might have seen the bully, the victim, or witnesses get into. Also, please indicate if it appears the victim was forced into a car.
The School District of Escambia County
Report Bullying
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Indicates required field
Elementary School
Middle School
High School
Special Center
Unknown
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Select School:
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Your Name (Optional):
First Name:
Last Name:
Who are you:
Concerned Citizen
Parent
Staff
Student
Your Contact Information (Optional):
Address:
City:
State:
Zip Code:
Primary Phone Number:
Alternate Phone Number:
*
Victim(s):
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Perpetrator:
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Describe the incident:
(Who, what, when, where)
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List all witness(es):
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Where did this incident take place?
(select all that apply)
Bathroom
Cyberbullying
Parking Lot
Bus Stop
Front of School
P.E. Fields
Cafeteria
Hallways
P. E. Locker Rooms
Classroom
Library
Playground
Common Areas
Lockers
School Bus
Other Location:
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How often has the bullying behavior occured?
select
First Time
2 Times
3 Times
4 Times
5 or More Times
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Have you reported the bullying incident to anyone?
Yes
No
If yes, to whom did you report the incident?
Enter any additional information that may help the investigation?
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