Bully Report

The NLCS Bullying report form allows you to submit anonymous tips to school and District officials of alleged bullying. If there is an emergency please call 911. 

1. Did the sender witness the bullying? YES | NO 

2. Who is the sender? STUDENT | PARENT/GUARDIAN | STAFF | OTHER 

3. Name(s) of the person being bullied? 

4. Name(s) of alleged bully or bullies? 

5. In what building did the bullying take place? 

6. Location(s)? (Ex: Classroom, Hallway, Bus, etc.) 

7. Description of Bullying Events (Please leave as much detail as possible, including direct quotes and/or specific words used.) 

8. Has any action already been taken to stop the bullying? If so, provide details. 

9. Students/Staff who may have witnessed the bullying? 

10. Other Information: 

11. Sender’s Name (Optional) 

If you would like a direct-response, please leave your contact information. (Phone Number or Email)