Stacey Jr. Senior High Bullying Report Form
Thank you for reporting bullying. We have a zero tolerance policy for any type of bullying at our school. If you feel you are in immediate danger, please contact the nearest adult. You can contact our Junior High Counselor, Mrs. Nicholson, at 210-357-5108 (Nicholson.j@lacklandisd.net), our Senior High Counselor, Mrs. Medellin-Keller, at 357-5102
(medellin-keller.g@lacklandisd.net), or our Vice Principal, Mr. Shelby, at 357-5104 (shelby.h@lacklandisd.net)
Your Name:
Your answer
Date:
Your answer
What Happened?
Your answer
Who is the victim?
Your answer
What is the bully's first and last name?
Your answer
What kind of bullying is it?
Required
How many ways have they bullied you?
Your answer
Is it one individual or a group of people bullying you?
How long has this been going on? Or is it frequently happening?
Your answer
Do you and the bully have a history of problems?
Your answer
Where is the bullying taking place?
Did the bully have weapons?
Your answer
Are there any witnesses?
Your answer
What kind of steps have you taken?
Your answer
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