Bullying Prevention & Intervention Incident Reporting Form
At South Harrison Community School Corporation part of our Mission is to provide a safe and supportive learning environment that promotes respect for all stakeholders.Bullying behavior works against our Mission and therefore will not be tolerated. Please read the definition of bullying listed below and seek assistance when there is a concern.

"Bullying" (per IC 20-33-8-.2) means overt, unwanted, repeated acts or gestures, including verbal or written communications or images transmitted in any manner (including digitally or electronically), physical acts committed, aggression, or any other behaviors, that are committed by a student or group of students against another student with the intent to harass, ridicule, humiliate, intimidate, or harm the other targeted student and create for the targeted student an objectively hostile school environment.

Email address *
First Name
Your answer
Last Name
Your answer
Are you the: *
Required
Name of the Aggressor (person who engaged in behavior) *
Your answer
Check whether you are a: *
Required
Name of Target *
Your answer
Date of the Incident *
MM
/
DD
/
YYYY
Location of the Incident (Be as specific as Possible) *
Your answer
Witnesses to the Incident (Include anyone who saw the incident or who can verify the incident) *
Your answer
Type of behavior that is of concern? *
Required
Describe the details of the incident (include names of people involved, what occurred, and what each person did and said. Be sure to include specific words and actions.) *
Your answer
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