Incident Reporting Up Form

At Rocklin Academy, we are committed to building and maintaining a caring school community. We want an environment in which students, educators and adults work together for the social, physical, and emotional well-being of all members. We are committed to humane interactions, social connections, and growth for all members. Bullying, harassment, or intimidation are serious and will not be tolerated. This is a form to report alleged bullying harassment, or intimidation that occurred on school property; at a school-sponsored activity or event off school property; or on the way to and/or from school, in the current school year. If you are a student victim, the parent/guardian of a student victim, or a close adult relative of a student victim, or a school staff member, and wish to report an incident of alleged bullying harassment, or intimidation, complete and submit this form. Contact the school for additional information or assistance at any time.

Please complete the form below. Mandatory fields marked *

Personal Information (Optional)

  • On what date(s) did the incident happen? - - (mm-dd-yy)

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Verification Code: (* required)
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