Bully Report Form
"Bullying involves a desire to hurt, intimidate, a power imbalance, repetition, an unjust use of power, evident enjoyment by the aggressor and a sense of being oppressed on the part of the target" (from the MGSD Code of Conduct).
Students can use this form to report bullying to their school counselors. School counselors will follow-up with the victim as soon as possible. We will *never* tell the bully who made the report -- your safety is our priority.
Victim's First Name
Your answer
Victim's Last Name
Your answer
Victim's Grade Level
Bully's First Name
Your answer
Bully's Last Name
Your answer
Date of Most Recent Occurrence
MM
/
DD
/
YYYY
Location of Most Recent Occurrence (include details such as room number, hallway, bus number, lunch table number, etc)
Your answer
Witnesses to Most Recent Occurrence (Include first and last names, if possible. We may need to contact them to ask questions.)
Your answer
Describe the bullying in as much detail as possible.
Your answer
Submit
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