Bullying Report Form
In accordance with state law, bullying is defined as intimidation, unwanted aggressive behavior, or harassment that is repetitive or is substantially likely to be repeated and causes a reasonable student to fear for his or her physical safety or property; that substantially interferes with the educational performance, opportunities or benefits of any student without exception; or that substantially disrupts the orderly operation of the school. Bullying includes, but is not limited to: physical actions, including violence, gestures, theft, or property damage; oral, written, or electronic communication, including name-calling, put-downs, extortion, or threats; or threats of reprisal or retaliation for reporting such acts.
School you attend:
Clinton High School
Clinton Technical School
Clinton Middle School
Clinton Intermediate School
Henry Elementary School
Clinton Early Childhood Center
Please describe what happened:
Where (school and location, i.e. hall, lunch room, playground, etc.) did the incident occur?
Were there any witnesses? If so, who?
How often has the bullying and/or harassment occurred?
How have you responded to the bullying and/or harassment?
Have you spoken with anyone about the incident? If so, who?
How can we contact you if we need more information?
Please complete the captcha before submitting the form.
Never submit passwords through Google Forms.
This form was created inside of Clinton School District.
Terms of Service