The School District of Escambia County
School Violence Reporting System
Report Harassment
Is this report being given directly to a School District Employee?
If yes, Name of Person Receiving Report: 

* Indicates required field

*Select School:  
Your Name (Optional):  
First Name:
Last Name:
Who are you:         
Your Contact Information (Optional):  
Zip Code:
Primary Phone Number:
Alternate Phone Number:
  *Describe the incident:  (who, what, when, where)
  *List all witness(es):
  Where did this incident take place? (select all that apply)
Other Location:
*How often has the bullying behavior occured?
Have you reported the bullying incident to anyone?       
If yes, to whom did you report the incident?
Version: 1.5