Form Center

By signing in or creating an account, some fields will auto-populate with your information and your submitted forms will be saved and accessible to you.

Bullying Report

  1. The Derby Police Department supports USD 260 in creating a safe, friendly, and fun environment where students want to come and learn. Reporting of bullying actions is essential to achieving that goal. In your report, please include all information you feel will be helpful in the fields provided. Required fields are marked with an asterisk(*).When you have completed the report, click “SUBMIT” at the bottom. This site is reviewed each weekday, usually at about 8 a.m. All information provided will be kept confidential. Your report will be reviewed by the Derby Police Department. Reports of bullying that occurs on USD 260 property or at a school-sponsored event will be forwarded to USD 260. IF THIS IS AN EMERGENCY, CALL 911 IMMEDIATELY! Our number one concern is student safety. [Intentionally making a false report to the police is a crime. USD 260 students should always report bullying concerns to both school administration and a parent.]

  2. First, Last

  3. Has the appropriate teacher, coach, or bus driver been contacted?

    Check one

  4. Separate with a comma.

  5. Separate with a comma.

  6. Did anyone witness the action?

    Check one

  7. Separate with a comma.

  8. Where did the incident happen?

    Check one

  9. Please select a statement that best describes what happened during the incident

    Check all that apply.

  10. Describe

  11. Describe

  12. Did a physical injury result from this incident?

    Check one

  13. Is there any additional information you would like to provide?

    Check one

  14. First, Last (optional)

  15. Optional

  16. Optional

  17. Leave This Blank:

  18. This field is not part of the form submission.