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SY 2019-20 Safe Schools and Bullying Prevention **Bullying Reporting Form**
HOT LINE: (617) 592-2378
BOSTON PUBLIC SCHOOLS
Succeed Boston - Safe and Welcoming Schools
Email: saws@bostonpublicschools.org

For ALL NON-BPS Schools including charter schools in the city of Boston please call the Department of Elementary and Secondary Education (DESE) at 781-338-3700. Thank you!

Definition of Bullying: According to the Massachusetts Department of Elementary and Secondary Education, bullying is defined as "the repeated use by one or more students [aggressor(s)] of a written, verbal or electronic expression or a physical act or gesture or any combination thereof, directed at a target that: (i) causes physical or emotional harm to the target or damage to the target's property; (ii) places the target in reasonable fear of harm to him/herself or of damage to his/her property; (iii) creates a hostile environment at school for the target; (iv) infringes on the rights of the target at school; or (v) materially and substantially disrupts the education process or the orderly operation of a school. For the purposes of requirements related to this law, bullying shall include cyber-bullying. See Section 5 of the legislation for more details on the definition of cyber-bullying and more". For more information visit the Boston Public Schools anti-bullying page: https://www.bostonpublicschools.org/antibullying

All Safe Schools and Bullying Prevention hotline calls will be answered by trained counselors from the Boston Public Schools Succeed Boston. All allegations made will be forwarded to Principals and Headmasters. It is imperative that the Principal, Headmaster or his/her designee contact the parent/ legal guardian within 48 hours upon receipt of the report. Collaboration with parents is essential to identify the issues occurring at school as well as developing the best safety and or action plan to remedy the situation.

All investigations, findings, and recommendations must be completed within 5 school days and results shared with parents of alleged targets and aggressors. Upon completion the investigation must be sent via this form (Safe Schools and Bullying Prevention - Investigation Form) to Safe and Welcoming Schools - Succeed Boston Department. For questions email saws@bostonpublicschools.org.

Please note: All allegations regarding bullying based on race, color, national origin, ethnicity, religion, sex, sexual orientation, gender identity, disability, age, genetics, or active military status will be submitted to the Office of Equity for review of potential civil rights violations. If you answered yes for any of these items, please answer YES for question number 12.
Email address *
Start time of call: *
Time
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If you are filing this bullying allegation for someone else please read the following to the reporter: **Please note that a staff member or Principal/Headmaster from the school of the students involved in this allegation will contact the person or family making the bullying complaint within 2 school days to inform that they have received this allegation. An investigation should be completed and shared with the reporter or family of the student who is being the target of bullying within 5 school days. If you don't receive any information from the school within 5 school days please call or text the Hotline service again. Thank you! *
1) NEW! Beginning school year 2019-2020 a copy of this form will be shared with the reporter (person making this allegation). List the email address of the reporter. Write "anonymous" if reporter does not want to share their name. *
Your answer
2) Name and telephone of the person reporting the bullying allegation. Write "anonymous" if reporter does not want to share their name.(Note: Reports may be made anonymously, but no disciplinary action will be taken against an alleged aggressor solely on the basis of an anonymous report.) *
Your answer
3) Today's Date: *
MM
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DD
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YYYY
4) Form of Report: *
5) Name of the student who is the target of bullying? (You may provide more than one name) *
Your answer
6) Grade of the student who is being targeted? *
7) What is the name of the school of the student who is being targeted? *
8) Name of the student who is engaging in the bullying behavior? (Here type the name of the aggressor or aggressors) *
Your answer
9) Grade of the student who is engaging in the bullying behavior? *
10) Is the student engaging in the bullying actions from a different school? If yes, please type the name of the school below: *
11) Date, time, and location of the incidents? *
Your answer
12) If the bullying is happening on a school bus, please list the bus number
Your answer
13) Witnesses: List the name of the people who saw the incident or have information about it:
Your answer
14) Is this allegation a civil rights violation? “Civil rights violation” means bullying (including cyber-bullying), harassing, or hazing that target a student upon the students’ identification as part of any group protected from discrimination. (Race, color, national origin, ethnicity, religion, sex, sexual orientation, gender identity, disability, age, genetics, or active military status.) All reports regarding civil rights violations will be forwarded to the Office of Equity for tracking and, if necessary, further investigation, (Sections 1, 21.1 and 21.2 of the Code of Conduct). *
Required
15) Describe the details of the incident (including names of people involved, what occurred, and what each person did and said, including specific words used). You may send evidence to saws@bostonpublicschools.org. *
Your answer
16) Signature of the person completing the electronic bullying form. Type your name if you are completing the form for somebody else. *
Your answer
End time of call: *
Time
:
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