This form will allow anyone with information that could prevent or stop behavior such as bullying, harassment, threats, intimidation or acts of violence to share that information with school district administration. Information obtained will be investigated and appropriate action will be taken. This tool will allow parents, students and anyone with information that can protect students to report to the school district immediately. The Coffee County School System technology department developed this feature as part of the district website to protect all students and staff. Please do not use this system for issues requiring immediate assistance. If an emergency needs to be reported, please call 911.
Your Information (optional)
First Name
 
Last Name
 
Email:
 
Phone:
 
Address:
 
City:
 
State:
 
ZIP:
 
Incident Information:
When did this incident happen?
 
Where did this incident happen?*
Your Role:*
Type of harassment, intimidation, bullying, or harm:
Please enter as much information as possible about the type of bullying you are reporting.
 
Cause of harassment, intimidation, bullying or harm:*
Method of harassment, intimidation, bullying or harm:*
Who was the person being harassed, intimidated, bullied or harmed?
Please enter the victim(s) names if you have them.
 
What is the victim(s) age or grade?
Victims Age or Grade
 
Who was harassing, intimidating, bullying or causing harm?
Please enter the names of the bullies if you have them
 
What is the offender(s) age or grade?
Offenders Age or Grade
 
Description
Please give us as much additional information as you can about the incident