Bullying Incident Report

Parents and Students:

It is important to us to make Adams Central a safe learning environment. According to Section 5220 : Bullying Policy, Adams Central Community Schools prohibits acts of bullying of a student.

We have constructed the following document, which will allow you to anonymously report any bullying incidences

Bullying is defined as the following:


1. An intentional act

2. An act that occurs repeatedly (usually over a certain period of time)

3. Is a relationship that is characterized by an imbalance of power or strength (the person has a hard time defending himself or herself.



This includes Cyber bullying which could be any of the following:

1. Text messages

2. Twitter

3. Email

4. Facebook


Please know that quite often an incident of bullying is not reported to school officials for fear of retribution. Or, at times when those incidents are reported to school officials, student names are omitted from the report. The more information we have, the better we can intervene directly with the bully victim and the actual student(s) who initiated the bullying. We thank you for taking time to complete this survey. This will help all of us who work with our students to create a safe learning environment here at Adams Central Community Schools.


Please complete this report as honestly and accurately as you can.