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Report for Possible Bullying @AIS
This form is designed to help Academy Intermediate Staff create a positive and bully free environment.
Person you believe is bullying:
a student @Academy Intermediate
a parent of an Academy Intermediate student
a community member
The person who is the target of the suspected bullying:
Name of school adult you've already contacted (if any):
What date did the suspected bullying occur?
Where did the incident happen?
during a school activity
off school property
Please check the item(s) that best describe what happened:
damage to property
excluding me from activities
hazing (Club, team, class, other)
intimidation directed at me
offensive writing or graffiti
physical harm or threats of harm
repeated inappropriate behavior
slurs, rumors, jokes
threats (to me, friends, school)
Were there witnesses?
If there were witnesses, please provide their names:
Are there texts, notes, pictures, screen shots, or other evidence of the event(s) you are reporting?
Did a physical injury occur as a result of this incident?
Please add any additional information you think might assist in this case:
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