Longfellow Elementary School-Bullying Report Form English
Date *
MM
/
DD
/
YYYY
To: Principal/Assistant Principal
From (Optional):
Your answer
OR-Parent's Name
Your answer
Who is the student/person that is bullying you? *
Your answer
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?
Your answer
What would you like to happen? *
Your answer
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...)
Your answer
Submit
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