Malone Middle School
15 Francis Street, Malone, NY 12953
Phone: (518)483-7801, Fax (518) 483-9497
Principal: James C. Knight, Jr.
Assistant Principal: Dustin Relation (Dignity Act Coordinator)
Athletic Director: Eileen Kilcullen (518) 483-7807, ext. 7396
BULLYING & HARASSMENT ANONYMOUS
If you have any information regarding bullying/harassment and would like to report this information anonymously, please fill out the following form to the best of your ability and click submit. Please note: Making false allegations, providing discriminatory statements and making defamatory statements is prohibited and engaging in such activity will be reported to the appropriate authorities.
If you fear that a student is in immediate danger, please call the Malone Village Police Department at 483-2424, the New York State Police at 483-5000, or 911.
Indicates required field
Person Making the Report (optional)
Target/Victim's Name (First & Last)
Alleged Bully's Name (First & Last)
Name of Witness #1
Name of Witness #2
Where did the incident happen? (choose all that apply) *
on school property
on a school bus
cyberbullying (on an electronic device, cell phone, computer, tablet)
at a school sponsored event off school property
on the way to/from school
Date of Incident (___/___/___)
Time of Incident
Frequency of Incidents
Alleged Bully's Grade
Which statement(s) best describes what happened? (choose all that apply) *
destruction of property
sexual, religious, or racial harassment
If witnesses were involved, describe their role in the incident
Describe what happened.
List evidence of bullying (letters, texts, posts, photos, etc.)