Mosinee School District Bullying Reporting Form
Have you been a victim of bullying or been a witness to bullying but don't feel comfortable talking to an administrator? Use this form to report the incident. You can choose to report this anonymously or you can include your name for follow up. Please be as detailed as possible.
Is it Bullying or a Conflict?
Before you report someone for bullying you, please review the definitions of conflict and bullying.

Conflict is defined something that generally happens in the heat of the moment. Those involved have a difference of opinion and may be upset. Conflict does not happen all of the time and is not planned. Some may characterize conflict as an argument or disagreement. Those involved in conflict have the power to change the situation and sort out the differences.

Bullying is more serious and can be defined as follows:
- There is an Imbalance of Power: Kids who bully use their power—such as physical strength, access to embarrassing information, or popularity—to control or harm others. Power imbalances can change over time and in different situations, even if they involve the same people.
- Repetition: Bullying behaviors happen more than once or have the potential to happen more than once.

Bullying includes actions such as making threats, spreading rumors, attacking someone physically or verbally, and excluding someone from a group on purpose. It is more of a deliberate act and there is the intention to hurt, insult or threaten the other person.

What type of incident is this?
Has this incident happened before?
Name of Person(s) involved
Your answer
Your name (optional)
Your answer
Date of bullying incident
MM
/
DD
/
YYYY
Where did this incident occur?
Your answer
Were there any other witnesses to this incident? If so, please list name(s).
Your answer
What school are you in?
Describe the incident in detail.
Your answer
Do you have visual evidence of the bullying, such as an image or screen shot?
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