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Harassment, Intimidation or Bullying (HIB) Incident Reporting Form

The district is committed to a safe, civil educational environment for all students that is free from harassment, intimidation and bullying. Complete this form to report an incident. 

Questions? Contact your school principal, counselor, a trusted adult or CVSD District Compliance Officer (Title IX, Civil Rights, Gender Equity, HIB) Tricia Campbell at 509-558-6561 or [email protected]

CVSD School(s) Involved:
Check any that apply.
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Was law enforcement contacted in regard to this incident?
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Are the parents/guardians of the alleged victim aware of this incident?
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Place(s) Where the Incident(s) Happened:
Check any/all that apply.
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Check the box(es) that best describe what the alleged agressors did.
Check any/all that apply.
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Were there any witnesses/bystanders?
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Did a physical injury result from this incident(s)?
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Was the targeted student absent from school as a result of the incident(s)?
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Thank you for reporting this incident(s).

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