Richland-Bean Blossom Community School Corporation Bullying Form: Please complete all of the areas below that you can. Information that is (*) starred is required. Thank you.



Who Are You?


Person Reporting Bullying (First Name and Last Name)(*)

Please let us know your name.

What is Today's Date(*)

Please select today's date.

When did the bullying happen?(*)

Tell us when it happened.


Who Was Bullied?


Who do you think was bullied? (First Name and Last Name)(*)

Please let us know the bully's name.

Where does this person attend school?

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Who is this person's teacher?

Please write a subject for your message.

What grade?




Who Is The Bully (or Bullies)?


Who do you think was bullying?(*)

Please let us know the person's name.

What grade?

Please let us know your name.

Type of Bullying (check all that apply)(*)








Select one type.

Where did the bullying happen? (check all that apply)(*)









Tell us where the bullying happened.


Other Information


Is this the first time that this has happened?(*)

Please answer this question.

Have you filed a Student Bullying Report before?(*)

Please answer this question.

Who has been told about the bullying or saw what happened? (check all that apply)(*)








Please tell us this.

Any other information that you would like to share?



Please 'Type the (security) Text' in the space below and click the 'Send' button.(*)

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EHS Mission Statement

The mission of Edgewood High School is to develop responsible, self-motivated, and culturally aware citizens in an engaging learning environment that includes a wide range of curricular and extracurricular experiences. We challenge our students to achieve the highest individual level of success as knowledgeable, resourceful learners who emerge as critical thinkers, communicators and collaborators.