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Scotland County Schools Bullying Report
I.E. Johnson Elementary School
Have you reported this event to anyone in authority?
This could include a teacher, principal, or staff member at a school.
Name of person allegedly being bullied.
Please put first and last name if known
Where did this incident take place?
at bus stop
Date of alleged incident
Name of alleged bully.
The alleged bully is a:
This question is optional.
I am a:
person being bullied
Please check all that apply.
Physical: Hitting, kicking, or other physical aggression
Verbal: Teasing, name-calling, put-downs, or other behavior that would hurt others'feelings or make them feel bad
Exclusion: starting rumors, telling others not to be friends with someone, or other actions that would cause someone to be without friends.
CyberBullying: Using a computer, cell phone, or other electronic device to engage in any previously mentioned bullying.
Description of event
Please be specific and include location, date, and time
Did you witness the event?
If you did not witness the event, how were you made aware of what happened?
Please list other students/staff who witnessed the event.
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