Bullying, Harrassment, or Intimidation Reporting Form

Directions: "Bullying" or "harassment" is any gesture or written, verbal,graphic. or physical act ( including electronically transmitted acts - i.e., cyber bullying, through the use of the Internet, cell phone, personal digital assistant (pda) computer, or wireless handheld device, currently in use or later developed and used by students) that is reasonably perceived as being dehumanizing, intimidating, hostile, humiliating, threatening, or otherwise likely to evoke fear or physical harm or emotional distress and may be motivated either by bias or prejudice based upon any actual or perceived characteristic, such as race, color, religion, ancestry, national origin, gender, sexual orientation,, gender identity or expression; or mental or physical, or sensory disability or impairment; or by any other distinguishing characteristic, or is based upon association with another person who has or is perceived to have any distinguishing characteristic. Bullying and harassment also include forms of retaliation against individuals who report or cooperate in an investigation under this policy. Such behaviors are considered to be bullying or harassment whether they take place on or off school property, at any school-sponsored function, or in a school vehicle or at any time ot place where a child's imminent safety or over-all well-being may be at issue.
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    Person Reporting Incident

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    Must select at most 5 options.
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    Must select at most 3 options.
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