Report an Incident - Summit Charter School

370 Mitten Lane, Cashiers, NC 28717
828-743-5755 • Email • Webmail • Calendar

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Date: 20 December 2018

08

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Date: 08 January 2019

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Summit Charter School

Bullying Incident Report

Please help us combat bullying and/or harassing behavior within the Summit Charter School. If you have witnessed or know about an incident of bullying or harassing behavior, please use the form below to report it. You may choose to remain anonymous, if you wish. If you'd prefer to discuss this matter directly with a school official, please call (828) 743-5755 or email us.

Date & Time of Incident(*)

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Your Name(*)

Please type your full name.

Where did the incident in question occur? (i.e. - bus stop, soccer field, Facebook, etc.)(*)

Please enter the location of the incident before continuing.

Please list the name(s) of the bully or bullies that participated in this particular incident. If you do not know the name(s), please describe the individual to the best of your ability (i.e. - age, height, weight, physical features, etc.)(*)

Please enter the name(s) of the bully(ies) before continuing.

Please list the name of the individual(s) that were the target(s) of the bullying or harassing behavior you are reporting.(*)

Please enter the name of the targeted individual(s) before continuing.

Please describe the incident in question as clearly as possible and with as many details as you can remember. *(*)

Please describe the incident in question before continuing.

Were there any other witnesses to this incident? If yes, please list their names and/or roles (i.e. - parent, teacher, police officer, etc.) if you know them.(*)

Please indicate and list any witnesses to the incident before continuing.

Have you reported this incident to anyone else? If so, please list their names and/or their roles.(*)

Please indicate if you have relayed this incident to others before continuing.

May we contact you regarding the details of this incident?(*)

YesNo Please indicate your desire to be contacted regarding this incident before continuing.

When should we contact you?

Please select a date when we should contact you.

How should we contact you?

E-mailPhoneMail

If you selected yes above, please provide the phone number, email address or physical address at which we should contact you.

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(*)

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Summit Charter School

370 Mitten Lane, Cashiers, NC 28717
828-743-5755
828-743-9157
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