Student Bullying Report Form

Your Information

How were you involved in the incident?

Incident Details

When did the incident happen?

Where did the incident take place?

If there were any witnesses, please provide their names here.

Please explain what happened.







Who else have you reported this incident to?

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Susquehanna Community
School District

3192 Turnpike Street
Susquehanna, PA 18847
Phone: (570) 853-4921

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Confidential Issue? Call (570) 853-4921 extension 1340

Confidential Issue or Question?

Call Our Anonymous Tip Line:
(570) 853-4921 ext. 1340 or 2344

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