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.
Email address
Individual Reporting:
Your answer
School you attend:
Individuals involved:
Your answer
Please describe what happened:
Your answer
Where (school and location, i.e. hall, lunch room, playground, etc.) did the incident occur?
Your answer
Were there any witnesses? If so, who?
Your answer
How often has the bullying and/or harassment occurred?
Your answer
How have you responded to the bullying and/or harassment?
Your answer
Have you spoken with anyone about the incident? If so, who?
Your answer
How can we contact you if we need more information?
Your answer
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