BULLYING PREVENTION AND INTERVENTION INCIDENT REPORTING FORM
If you believe you have been the victim of bullying or you know someone who has, use the form below to report the incident(s). Though you may include your name and contact information at the top of the form, you may also choose not to.
Bullying is defined as the repeated use by one or more students of a written, verbal or electronic expression or a physical act or gesture or any combination thereof, directed at the victim that causes reasonable fear of harm to himself or of damage to his property, creates a hostile environment at school for the victim, infringes on the rights of the victim at school, or disrupts the education process.
Cyber-bullying is defined as bullying through the use of technology or any electronic communication, which shall include but is not limited to electronic mail, internet communications, instant messaging, posting on social networking sites, or facsimile communications.
If you do not receive a response within 24 hours please contact the Office of the Superintendent at 508-486-5115.
Name of Reporter/Person Filing the Report:
Note: An anonymous reports will prompt an investigation; disciplinary action will not be taken solely on the merits of an anonymous claim.Your answer
Select the appropriate choice
I am the target of bullying
I am a reporter (not the target)
I am a
Below, list your phone number or e-mail address (optional):
If you are a student or staff member, check which school you attend:
Margaret Neary Elementary
Mary Finn School
Never submit passwords through Google Forms.
This form was created inside of Northborough Southborough Schools.