Carroll Consolidated School Corporation Bullying Form: Please complete all of the areas below that you can. Information that is (*) starred is required. Thank you.


Who Are You?

Person Reporting Bullying (First Name and Last Name) (*)

Please let us know your name.
What is Today's Date (*)

Please select today's date.
When did the bullying happen? (*)

Tell us when it happened.

Who Was Bullied?

Who do you think was bullied? (First Name and Last Name) (*)

Please let us know the bully's name.
Where does this person attend school?

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Who is this person's teacher?

Please write a subject for your message.
What grade?



Who Is The Bully (or Bullies)?

Who do you think was bullying? (*)

Please let us know the person's name.
What grade?

Please let us know your name.
Type of Bullying (check all that apply) (*)








Select one type.
Where did the bullying happen? (check all that apply) (*)









Tell us where the bullying happened.

Other Information

Is this the first time that this has happened? (*)

Please answer this question.
Have you filed a Student Bullying Report before? (*)

Please answer this question.
Who has been told about the bullying or saw what happened? (check all that apply) (*)








Please tell us this.
Any other information that you would like to share?


Please 'Type the (security) Text' in the space below and click the 'Send' button. (*)

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School Safe Zone!

postHelp us create a safer school zone!  Report bullying online.  Your reports are confidential and will be acted upon quickly. Thank you for making our schools safer!  Click here.

Information Links

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Non-Discrimination

CCSC is committed to equal opportunities and no employee or candidate for a position in this Corporation on the basis of race, color, religion, national origin, creed or ancestry, age, sex, marital status, or disability, shall be discriminated against, excluded from participation in, denied the benefits of, or otherwise be subjected to, discrimination in any program or activity for which the Board is responsible or for which it receives financial assistance from the U.S. Department of Education.

CCSC Complaint Coordinator
Title IX Compliance Coordinator
Keith Thackery, Superintendent
2 South 3rd Street
Flora, Indiana 46929
574-967-4113