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This form is intended for parents, teachers, and students to report any incident of harassment, intimidation, or bullying. All Weehawken Township School District staff members are required to enter their name and fill out ALL boxes. Everyone else can remain anonymous. However, if you want to be contacted for follow-up you will need to enter your contact information.


PLEASE NOTE: This form is being submitted to an electronic queue for investigation. There is no guarantee that it will be read immediately. In the event that you or the student is in imminent danger, please contact the school or your local police department immediately.
General
Date of Incident:

Time of Incident:
School:
When did the incident occur?
Indicate how you learned that a student may have been a victim of harassment, intimidation or bullying:
Target (Victim)
First Name:
Last Name:
Gender:
Grade:
Race/Ethnicity:
Age:
Victim Type:
Alleged Offender(s)
First Name:
Last Name:
Gender:
Grade:
Race/Ethnicity:
Age:
Offender Type:
Contact Info

First Name:
Last Name:
Address
City
State
Zip Code
Email:
Phone Number:
Best time to call:
Are you a family member or staff member?
Relationship (For Family/Non-Staff):
Role in School (For Staff):

Please select all that apply.

Verbal
Emotional
Physical
Electronic
Where did the incident happen (choose all that apply)?

Witnesses
First Name:
Last Name:
Witness Type:
Physical Evidence
If you feel that the incident was in any way motivated by any of the following please indicate by checking where appropriate
Choose Religion
Document Upload
Optional: Please attach any images, videos, or other files relevant to this incident. If you wish to select multiple files for upload, click "Choose Files" and then hold the Ctrl button on your keyboard while choosing each file.
Do not upload any images or videos of a sexual nature. Please keep total files under 10 MBs, Contact your district for additonal files.



Is there any additional relevant information that you would like to provide?
Be sure to enter all known information before submitting.