Person Reporting Incident
You may choose to report this information anonymously. All complaints will be treated in a confidential manner. Anonymous reports may limit the district’s ability to respond to the complaint.
Person completing this form
Student (witness/bystander of incident)
Name of Target
Name(s) of alleged offender(s)
Date(s) of Incident(s)
What is your School?
Choose a School
Barack Obama School for Social Justice
Boyce Thompson School
Casimir Pulaski School
Cesar E. Chavez School
Cross Hill Academy
Ella Fitzgerald Academy
Enrico Fermi School
Eugenio Maria de Hostos School
Family School 32
Gorton High School
Kahlil Gibran School
Las Hermanas Mirabal Community School
Lincoln High School
Martin Luther King, Jr. Academy
Montessori School 27
Montessori School 31
Museum School 25
Paideia School 15
Paideia School 24
Patricia A. DiChiaro School
PEARLS Hawthorne School
Riverside High School
Robert C. Dodson School
Roosevelt High School Early College Studies
Rosemarie Ann Siragusa School
Saunders Trades Technical High School
Thomas Cornell Academy
Westchester Hills School 29
Yonkers Early Childhood Academy
Yonkers Middle / High School
Yonkers Montessori Academy
Where did the incident happen?
On school property
Off school property
At a school sponsored activity
If you select Other, please fill the "Other Place" field bellow.
Place a check next to the statement(s) that best describes what happened (choose all that apply)
Physical (including, but not limited to, kicking, punching, spitting, taking belongings)
Verbal (including, but not limited to, taunting, malicious teasing, name calling, making threats)
Psychological (including,but not limited to, non-verbal actions, spreading rumors, social exclusion)
If you select Other, please fill the field "Other" bellow.
Background: Please describe what happened before, during and after the incident
Who else saw the incident occur?
What steps, if any, have been tried to resolve the issue?
To your knowledge, was the student victim absent from school as a result of the incident?