Please enter your name:

Who is the victim of the bullying?

Who is the bully?

What type of bullying is going on?
VerbalNon-verbalPhysical (pushing, hitting)RacistSexistHomophobicCyberOther
Further information.

Have there been any witnesses?

Did you do or say anything to start the bullying?
YesNo
If yes, please state what you have done or said.