Gilmer High School

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District	Campus
	CAMPUS

Anonymous Tip Line: 903-841-7499

Please complete this form to the best of your knowledge so we can assist you.
This information will be kept confidential with your campus administrator and/or superintendent.

Threatening/Violent Behavior Report Form

Date of Incident:

Date of Report:

Name of person engaged in threatening/violent behavior?

Grade of person(s) who engaged in threatening/violent behavior?

Name of victim/target? (Not required)

Grade of victim/target?

What type of treatening/violent behavior?

Physical

Emotional/Social

Damage to Property

Online

School threat

Bullying

Other:

Other location details: (Please explain the specific location details such as which hallway, where on the Internet, what restroom, etc)

Describe what happened with as many details as possible. Include the names of other people who may be familiar with the situation if possible.

Person reporting the incident-Please use your full name.

If you would like to request your identity remain confidential, please check this box. District employees may choose this option as well.

May we contact you for more information on this incident?

Yes

Thank you for reporting this incident. We appreciate your concern. When you click "Submit Form" this will be sent to the campus administrator.

Email a copy to

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Required Fields

Threatening/Violent Behavior Form