Report Form
Please take a moment to fill out the report form below completely as possible and send it to us. Escobedo does not tolerate bullying or harassment and your report will be followed up promptly.

VICTIM'S NAME:

Last Name:    First Name:  

Student Number:    Grade:  

PARENT'S NAME ( Optional--- helpful if you want to be contacted)

Last Name:    First Name:  

Contact Number:  -- Home: Cell: Work:

EMAIL ADDRESS:  

DESCRIPTION OF THE INCIDENT(S):  Please specify the name(s) of the person(s) who are bothering you, including what they are doing, where it occurs and when it happened.



Clicking the "SUBMIT" button will allow your web browser to mail the information to us.  

We will be contacting you shortly.

Close Window

9501 ECHELON POINT DR., LAS VEGAS, NV 89149 | Phone: (702) 799-4560 | Fax: (702) 799-4568
© Escobedo MS 2007