Conflict/Bully Report
This form is available to school in the media center for students to complete at anytime. Forms are turned into a locked mailbox and picked up by guidance counselors. Anytime they are addressed, parents should receive a Conflict/Bully meeting slip letting you know that a conflict was discussed with guidance or administrators and has seemingly been resolved. If the incident is not resolved the parent will be contacted via telephone.

The online form provided here can be completed at home. The form is submitted to guidance counselors.

WHO: Your Name (child's)
Your answer
Grade, Teacher
Your answer
Name of Person with Conflict or Bully
Your answer
Grade, Teacher
Your answer
Witness(es)
Your answer
Have you reported bullying by this person before?
WHAT: Write exact words (teasing words, gossip told to you by another person) or touching (push, hit, trip, slap, shaking fist, etc.)
Your answer
WHEN: Day and Time
MM
/
DD
/
YYYY
Time
:
WHERE
HOW: How did those around you respond? Example: Tell the person to stop, join in, say nothing
Your answer
Submit
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