MJHS Bullying Report Form
Morton Junior High School is committed to creating a safe and supportive learning environment for all students. School incidents involving bullying are taken very seriously at MJHS. When these incidents are reported, support services can be provided to all students involved. This includes the student being bullied, the offender, or a bystander.
As stated in the MJHS Handbook, the Illinois legislature defines bullying as meaning: any severe or pervasive physical or verbal act or conduct, including communications made in writing or electronically, directed toward a student or students that has or can be reasonably predicted to have the effect of one or more of the following:
1. Placing the student or students in reasonable fear of harm to the student's or students' person or property;
2. Causing a substantially detrimental effect on the student's or students' physical or mental health;
3. Substantially interfering with the student's or students' academic performance; or
4. Substantially interfering with the student's or students' ability to participate in or benefit from the services, activities, or privileges provided by a school

This form has been created to help provide a safe means of reporting an incident of bullying to school personnel. It is designed to remain anonymous and it is encouraged that bystanders of bullying incidents report their observations so appropriate action can be taken. Victims of bullying are also encouraged to use this form as well as reporting the incident directly to the staff at MJHS.

Thank you for taking the time to complete this form. MJHS appreciates your help in maintaining a safe environment for our students.

Your Name (Optional)
Name of the person reporting the bullying incident.
Your answer
I am a...
Please check the appropriate box.
Person being Bullied
Please list the name of the person (first & last name) being bullied.
Your answer
Person doing the bullying
Please list the name of the person (first & last name) doing the bullying.
Your answer
Today's date
MM
/
DD
/
YYYY
Type of Bullying
Please check the type(s) of bullying that has occurred.
Description of Events
Please provide a detailed description of events. Include location, date, time, etc.
Your answer
Witnesses
Please provide names (first & last name) of any possible witnesses.
Your answer
Submit
Never submit passwords through Google Forms.
This form was created inside of Morton Unit District 709. Report Abuse - Terms of Service - Additional Terms