Request edit access
Nettle Creek School Corporation
Report Form for Reports or Complaints of Bullying
Email address *
"Bullying" is a legal term in Indiana. To be considered "bullying", actions whether verbal, written, or physical must be repeated, overt, and unwanted by a student or group of students against another student with the intent to harass, ridicule humiliate, or harm the other student. If you feel that the actions you have witnessed meet the legal definition as described, please proceed with the form below. *
Required
Complainant
Person filing report. Information may be filed and processed anonymously.
Your answer
School Building *
Home Address
Your answer
Home Phone
Your answer
Name of person you believe bullied you or another person. *
Your answer
If the alleged bullying was toward a person other than yourself, identify the other person.
Your answer
Dates and Time of Alleged Incidents *
Please list dates and times of "bullying" incidents that have occurred with the alleged "bully".
Your answer
Describe the event as clearly as possible including such things as what force, if any, was used, any verbal statements (threats, demands, requests, etc.) that were made, and any other relevant details. *
Your answer
Where did this occur? *
Your answer
List any witnesses who were present.
Your answer
This complaint is based upon my honest belief that the above mentioned individual has bullied me or another person. I understand that students who falsely report bullying may be subject to school discipline. This may include discipline up to expulsion and shall be dependent upon the nature of the false allegation. I also understand that students who allege bullying by another students may not be automatically exempt from counter allegations of bullying by that student or another student. By clicking below, I hereby certify that the information contained in this report is true, correct, and complete to the best of my knowledge. I also understand the consequences of knowingly filing a false report. *
Required
Submit
Never submit passwords through Google Forms.
This form was created inside of Nettle Creek School Corporation. Report Abuse - Terms of Service