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Bullying Report Form - Annunciation School
At Annunciation, we are devoted to creating an open, inquisitive, positive climate for learning while affirming and respecting the diversity and uniqueness of each individual. To help us promote a positive culture, we are offering another venue to report concerns of bullying behavior.

Definition of bullying:
Bullying is unwanted, aggressive behavior among school aged children that involves a real or perceived power imbalance. The behavior is repeated, or has the potential to be repeated, over time. Both kids who are bullied and who bully others may have serious, lasting problems.

In order to be considered bullying, the behavior must be aggressive and include:
An Imbalance of Power: Kids who bully use their power—such as physical strength, access to embarrassing information, or popularity—to control or harm others. Power imbalances can change over time and in different situations, even if they involve the same people.
Repetition: Bullying behaviors happen more than once or have the potential to happen more than once.

Person filling out the report *
Your answer
Contact Information - please add your phone number or any additional information which may be useful in the event we need to contact you. *
Your answer
Check whether you are: *
Check whether you are: *
Required
Date of the incident *
MM
/
DD
/
YYYY
Nature of alleged bullying behavior (Check all that apply) *
Required
Who was bullied? (Please list first and last names and grade levels of all students, if reporting multiple students). *
Your answer
Who did the bullying? (Please list first and last names and grade level of all students, of reporting multiple students). *
Your answer
Were there any bystanders? If yes, please list by first and last names. *
Your answer
Where did it happen? *
Your answer
Time of the incident *
Time
:
Has this happened before? *
If yes, please describe the previous incident(s). *
Your answer
Describe the details of the incident (Include the names of people involved, what occurred, and what each person said, including specific words used or actions taken.) *
Your answer
Is there any other information we need to know? *
Your answer
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