Beeville ISD - Fadden-McKeown-Chambliss Elementary School

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FMC Elementary

Please complete this form to the best of your knowledge so we can assist you. Add as much information as you can including the date, time and location of the incident. Be sure to include what school you are associated with.

Please Fill Out The REPORT A BULLYING INCIDENT Below

Date of Alleged Incident:

Date of Report:

Who was the person(s) allegedly engaged in bullying?

Grade of person(s) who engaged in bullying?

Who was being bullied?

Grade of person who was being bullied?

What type of bullying?

Physical

Emotional/Social

Damage to Property

Online

Other:

Other location details: (Please explain the specific location details such as which hallway, where on the Internet, what restroom, etc)

Describe what happened with as many details as possible.

Person reporting the incident:(OPTIONAL). Please use your full name.

May we contact you for more information on this incident?

Yes

Thank you for reporting this incident. We appreciate your concern. When you click "Submit Form" this will be sent to the campus administrator.

Email a copy to

optional

Required Fields

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