Longfellow Elementary School-Bullying Report Form English
To: Principal/Assistant Principal
Who is the student/person that is bullying you?
Give specific examples of how you're being bullied?
For example: PHYSICAL: hitting, pushing, kicking, biting...etc...VERBAL: name calling, profanity, made fun of in front of others, starting rumors about you, "cyber-bullying." HOW OFTEN HAS THIS BEHAVIOR OCCURRED?
What would you like to happen?
Describe the informal efforts you made to correct the situation described. What actions have you taken to solve the situation?
(Walk away...Ask for help...Speak up for yourself...)
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This form was created inside of Riverside Unified School District.