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514.1 Bullying Report Form
Please fill out this form in it's entirety. You may choose to remain anonymous. However, that may limit some of our ability to investigate the situation. We encourage you to do what you feel is right.
What is your e-mail address?
Date of Occurrence
Please provide the names and grades of persons involved in this report.
Where did this incident take place?
What was the nature of the incident being reported (check all that apply)?
Physical (hitting, spitting, kicking, or damaging your or another students property)
Verbal (saying mean or hurtful things or threatening you or another student)
Social (excluding you or a student from a group, telling peers not to talk to you or another student)
Emotional (spreading rumors or lies about someone)
Cyber/Online (occurs on website, social media, cell phone, e-mail, and/or text message)
Please select any of the following in which the bullying may have been related to.
Gender or Gender Expression
Religious or Cultural Beliefs
Please describe the incident in detail.
Please list all of the possible witnesses with knowledge of the incident.
By checking the box below, you affirm that all information shared within this form is accurate and true.
The information in this form is accurate and true.
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This form was created inside of New London Spicer Schools.