River Bluff Confidential Bullying / Harassment Reporting Form
The Stoughton Area School District strives to provide a safe, secure and respectful learning environment for all students in school buildings and on school grounds, on school buses and at school-sponsored activities. This confidential form is submitted to building Administration and School Counselors, with a goal to be processed within 24-48 hours. If this is an emergency, please contact the River Bluff Office immediately at 877-5500.
Student First Name
Student Last Name
Who is submitting this form?
Parent / Guardian
Type of Incident
Student Conflict: An isolated, negative interaction that needs to be addressed by administration/staff..
Bullying: uses words or actions, intended to cause fear, or harm, and involves an imbalance of power.
Harassment: is motivated by actual or perceived characteristic protected by state or federal law.
Other: For example- theft, lost item, reporting a concern, locker issue
Name of student, if known, involved in this concern?
When did the event occur?
Past 24 hours
Where did the event happen?
Check all that apply
School Grounds / Recess Time
On the way to/from school
Internet / Social Media
Describe what happened:
Have you talked to anyone about this?
If yes, who?
Did anyone else see what happened?
If yes, please write their name(s):
A copy of your responses will be emailed to the address you provided.
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