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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.
High School of Bullying Incident
Libertyville High School
Vernon Hills High School
I am a: (Check the appropriate box)
Parent/Guardian of a student
Close adult relative of a student
Name of alleged student victim (if known)
Name of alleged offender(s) (if known)
Date of Incident
Time of Incident
Where did this incident happen?
On school property
On a school bus
At a school-sponsored activity or event off school property
On the way to/from school
Describe what happened
Has this incident been reported to anyone yet?
Who was the incident reported to?
Were there any witnesses?
Names of witnesses
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