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Stamford High School Bully Report Form
"Bullying" is a single significant act or a pattern of acts by one or more students directed at another student that exploits an imbalance of power and involves engaging in written or verbal expression, expression through electronic means, or physical conduct that satisfies the applicability requirements provided by Subsection (a-1), and that: (i) has the effect or will have the effect of physically harming a student, damaging a student ’s property, or placing a student in reasonable fear of harm to the student’s person or of damage to the student’s property; (ii) is sufficiently severe, persistent, or pervasive enough that the action or threat creates an intimidating, threatening, or abusive educational environment for a student; (iii) materially and substantially disrupts the educational process or the orderly operation of a classroom or school; or (iv) infringes on the rights of the victim at school; and includes cyber bullying. (2) "Cyberbullying" means bullying that is done through the use of any electronic communication device, including through the use of a cellular or other type of telephone, a computer, a camera, electronic mail, instant messaging, text messaging, a social media application, an Internet website, or any other Internet-based communication tool. SISD prohibits(1) bullying that occurs on or is delivered to school property or to the site of a school-sponsored or school-related activity on or off school property; (2) bullying that occurs on a publicly or privately owned school bus or vehicle being used for transportation of students to or from school or a school-sponsored or school-related activity; and(3) cyberbullying that occurs off school property or outside of a school-sponsored or school-related activity if the cyberbullying: (A) interferes with a student ’s educational opportunities; or (B) substantially disrupts the orderly operation of a classroom, school, or school-sponsored or school-related activity. Bullying is not tolerated by the district and any student or parent of a student who believes that the student or another student has experienced bullying or that a student has experienced bullying or that a student has engaged in bullying is encouraged to immediately report the incident. Retaliation against anyone involved in the complaint process is a violation of district policy and is prohibited. Students or parents may report an alleged incident of bullying, orally to a teacher, counselor, principal or another district employee. or by completing the online form accessible on the district website.Please note that after submission of the complaint an employee will be assigned to follow up on the submitted complaint and any other important matters pertaining to the complaint. We encourage you to communicate with your designated campus administrator during this time. More information about the district’s bullying policy can be found on the campus website or from campus administration.
I have read and understand the above definition of Bullying.
Name of Person Reporting- This is NOT a required question. Leaving this question blank will assure that this is anonymous.
Date & Time the Bullying Occurred
Who was bullying?
Who was being bullied?
Please select the statement(s) that best describe what happened.
cyberbullying (text, email, snapchat, instagram or other social media. etc.)
intimidated or felt a reasonable fear of harm or damage
teasing or name calling
making rude or threatening gestures
Hitting, kicking, shoving, spitting, hair pulling, or other physical harm
excluding the target student
getting another person to harm/threaten the target student in any of the above listed ways
Where did the bullying take place?
Bus (please provide bus number and or driver)
restroom (be specific which one)
on digital DEVICE- email, text or social media (please give some detail on which one)
Please include any other information concerning the incidents.
Please list any witnesses or bystanders (if any). Anyone who was around when the incidents happened and may have knowledge of bullying
Please list any other person(s) this been reported to.
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