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Fieldcrest CUSD #6 Bullying Report Form
Fieldcrest Community Unit School District #6 is committed to creating a safe and supportive learning environment for all students. The district board of education prohibits acts of harassment, intimidation or bullying of a student. The district board of education has determined that a safe and civil environment in school is necessary for students to learn and achieve high academic standards; harassment, intimidation or bullying, like other disruptive or violent behaviors, is conduct that disrupts both a student's ability to learn and a school's ability to educate its students in a safe and disciplined environment. School incidents involving bullying are taken seriously at Fieldcrest.

This form has been created to help provide a safe means of reporting an incident of bullying to school personnel. It is designed to remain anonymous and it is encouraged that bystanders of bullying incidents report their observations so appropriate action can be taken. Victims of bullying are also encouraged to use this form as well as reporting the incident directly to the staff at Fieldcrest.

Reprisal or retaliation against any person who reports an act of bullying is prohibited. A student's act of reprisal or retaliation will be treated as bullying for purposes of determining any consequences or other appropriate remedial actions. However, intentionally false and/or misleading reports will not be tolerated.

Thank you for taking the time to complete this form. Fieldcrest appreciates your help in maintaining a safe environment for our students


This form will checked at least once daily during the school year (August 16, 2018 to June 1, 2019)

School Location
I am a... *
Required
Persons Involved *
Your answer
Date of the Incident *
MM
/
DD
/
YYYY
Type of Bullying Please check the type(s) of Bullying *
Required
Description of Events - please provide a detailed description of events. Please tell the entire story including time, date, place of the event. *
Your answer
Other Witnesses - please list other students or staff who may have witnessed the situation.
Your answer
Optional - Enter your name
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