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Bullying/Harassment/Intimidation/Discrimination Report Form
Stay Safe. Speak Up! We are here to help you! As per Randolph County Policy 5517.01, Elkins High School is committed to providing a safe, positive, productive, and nurturing educational environment for all of its students. If you believe you or your child is being bullied or harassed or you suspect any type of discrimination please report it below. The information will not be shared with anyone other than those involved with helping you and investigating your issue. The more you can tell us, the more we can help! WARNING: Any person knowingly and willfully making a false or misleading report or counsels another to make a false or misleading report may be subject to criminal and/or civil liability. The IP address of the electronic device used for submitting information is logged and may be used to investigate a suspected false or misleading report.
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Indicates required field
Name
*
First
Last
Email
*
What is your phone number?
*
What is your role in the incident?
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Student
Teacher
Parent
Administrator
Staff
Bystander
Other
What is the name of the student being targeted?
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What is the grade of the student being targeted?
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What is the main issue or incident?
*
Abuse (Physical or Mental)
Bullying, Harassment, Intimidation
Discrimination (Race, Religion, Fender, Ethnicity)
Hacking, Cyber Crime (Social Media, Text, Email, etc)
Sexual Harassment
Threat
Violence or Fighting
Other
What date did the incident happen (M/D/YYYY)?
*
What time did the incident happen?
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Where was the location of the incident?
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What is the method of harassment, intimidation, bullying, or harm?
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Electronic Communication Sent OFF School Property
Electronic Communication Sent ON School Property
Written Communication
Verbal
Physical
Social/Relational
Who was harassing, intimidating, bullying, or causing the harm?
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What is the harasser(s) age or grade level?
*
Were there any witnesses? If so, please list their names.
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Describe the incident giving as much information as possible.
*
Submit
Home
About Our History
Contact
EHS School Store
Tora Donations
Academics
Academic Boosters
Educational Tours
Athletics
'24 School Year
Guidance
2024-2025 Course Offerings
Bullying and Harassment Report Form
New Student Enrollment
PEP Plan
Scholarship Info
LSIC
Meeting Notices
Yearbook
WELLNESS
Mark's Office