Bullying Report Form
BULLYING - C4 is committed to providing a safe, positive, productive, and nurturing education environment for all of its students. C4 encourages the promotion of positive interpersonal relations between members of the school community. Bullying behavior toward a student, whether by other students, staff, or third parties, is strictly prohibited and will not be tolerated. This includes physical, verbal, and psychological abuse, gestures, comments, threats, or actions which cause or threaten to cause bodily harm or personal degradation. Engaging in bullying behavior through the use of data or computer software that is accessed through a computer, computer system or computer network also is prohibited.

Any observed or alleged incidents should be reported immediately. All complaints of alleged bullying will be investigated. If determined to be a bullying incident, parents/guardians of the targeted student(s) will be notified of the alleged incident and investigation. If the nature of the incident is an illegal act, the incident will be reported to local law enforcement.

(excerpt from the C4 Student Handbook)

** If you need to report an incident (or multiple incidents) of bullying, please complete the form below. **

Name of person(s) being bullied: *
Your answer
Date bullying occurred (mm/dd/yyyy - example: 01/01/2000) *
Your answer
Name of bully: *
Your answer
Your name (optional):
Your answer
I am a: *
Required
Type of bullying (select all that apply): *
Required
Description of what happened: *
Your answer
Did you witness the bullying? *
List names of other students/staff who witnessed the bullying:
Your answer
May we contact you about this incident? If so, include name, phone number, email address or any other way you may be contacted.
Your answer
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