School & Student Safety Tip Line Reporting Form for Woodstock H. S.

School & Student Safety Tip Line Reporting Form: All information is confidential and will be submitted to the Guidance Counselor, Daryl Harris (daryl.harris@cherokee.k12.ga.us).
Name (optional): 


A red asterisk (*) indicates required questions.

Date of Incident*


Approximate Time of Incident*


This Incident*
Involved me
Involved another student
Involved someone other than a student


Aggressor Name:


Victim Name:


Type of Incident*
Abuse
Alcohol
Bullying
Cheating
Cutting or Self Injury
Cyber Bullying
Depression
Discrimination
Dropping Out
Drug Possession
Drug Sale
Drug Use
Eating Disorder
Family Problem
Fighting
Gangs
Health Issues
Peer Pressure
Pregnancy
Racial Issues
Sexual Harassment
Stress
Thank You / Compliment
Vandalism
Weapons
Other


Brief Description of Incident:*


Has this happened before?*
Yes
No


How many times has this happened before?


If you wish to be contacted please provide your contact information.