Report Cyber-Bullying

Please help fight cyber-bullying in Mancelona Middle School - Fill in the form below with as much information as possible.

If cyber-bullying occured through a text message or email - you can forward them to the email address below (without spaces and extra characters)

bully (@) mancelonastudents (.) org

Any information submitted will be sent to the Middle School Principal and District Media Specialist.

Where did the cyber-bulling occur (eg. Facebook, You-Tube, Text Message, Email, Online Chat)?: *

Please cut & paste the content of the cyber-bullying here, or cut & paste the URL of the website where the cyber-bullying occured:

Date: *

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Time:

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am

pm

Did the cyber-bullying occur during school hours?: *

No

Yes

Did this instance of cyberbullying disrupt student learning?: *

No

Yes

What is the bully’s first and last name?: *

If you would like to provide your name, please do so here. Your name will not be revealed:

CAPTCHA

This question is for testing whether you are a human visitor and to prevent automated spam submissions.

What code is in the image?: *

Enter the characters shown in the image.