Student Report Form


Fill out Student Report Form

Students, if you have concerns about peer interactions, bullying & harassment, please fill out the electronic Student Report Form, which is linked here on this page.

This form is also available in hard copy format in all classrooms, the counseling center, and the front office.  The Student Action Form can be directly submitted to the front office staff, and administration.

If you fill out the electronic version here, your concern will be directly submitted to school administration.

INSTRUCTIONS for filling out the electronic Student Action Form:

In order to access this electronic Student Action Form, students must be logged in to their Eugene 4j School District Google Documents account.

To ensure that a student is logged into their 4j Google Documents account, open another web browser window on the same web browser you are currently using to access this web page and access

Log into Google using your Eugene 4j email account.

Once you are logged into your Eugene 4j Google docs, come back to this web page and access the link to the electronic Student Action Form.  You should now have access (If you are still experiencing problems, please connect with an administrator, or please fill out a hard copy of the form as soon as possible).

Please follow the instructions to filling out the form, and please be sure to provide as much detailed information as possible.

Please be advised that your login will be automatically collected when you submit the form.  This will ensure that administration or another staff member can accurately and effectively follow-up with the student who submitted the form.
Thank you for taking the time to submit a Student Action Form.  Kelly Middle School is committed to having a safe, responsible and respectful learning environment and maintaining a harassment-free zone at school at all times is a high priority.