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District #128 - Bullying, Harassment or Intimidation Reporting Form
Bullying can take various forms, including but not limited to: harassment, threats, intimidation, stalking, physical violence, sexual harassment, sexual violence, theft, public humiliation, destruction of property, or retaliation for asserting or alleging an act of bullying. Bullying is a serious offense, is contrary to state law and prohibited in Community High School District 128. Board policies 7:180, 7:20, 7:190 and 7:240 expressly forbid bullying in any form and describe procedures and consequences regarding such action. Bullying of any type should be reported immediately.
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High School of Bullying Incident
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Name
E-mail Address
Telephone Number
I am a: (Check the appropriate box)
Name of alleged student victim (if known)
Name of alleged offender(s) (if known)
Date of Incident
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DD
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YYYY
Time of Incident
Time
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Where did this incident happen?
Describe what happened
Has this incident been reported to anyone yet?
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Who was the incident reported to?
Were there any witnesses?
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Names of witnesses
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