Bullying/Incident Form

 It is VERY important to us that our students feel safe at TCA. If a situation does arise, we want to handle it head on. If a student does not feel comfortable enough talking to us face-to-face about what is going on with them, then we have this web-based form they may fill out.

We encourage our students not to be shy about reporting a bully! We do not want our students to suffer and internalize their emotions, where they may cause more damage.

Bullying comes in many forms. The following are just a few examples:
  • Embarrassment
  • Harassment
  • Mean Looks
  • Teasing
  • Shoving
  • Rumors
  • Mean Notes
  • Cyber Bullying
  • Pinching

  • Stealing
  • Threats
  • Exclusion
  • Kicking
  • Hitting
  • Intimidation
  • Name-Calling
  • Assault
  • Bystander

Your Name (first and last)


Name of the person you are reporting

Contact Information (phone number, e-mail, etc.)

What date did this incident occur?

Around what time did the incident occur?

In what location did this incident occur?

Please list any witnesses to this incident.

Has this been an ongoing behavior?

If yes, please explain.

Please describe what has been done previously to submission of this form to solve this situation?

Please submit any other information you would like us to know.