Request edit access
Bullying Report Form
Acero Schools strives to provide and protect a safe learning environment for our students. Students, school staff, and parents/guardians who witness student bullying or who have information about actual or threatened bullying should immediately report it to the campus principal. Information can be provided orally or in writing by completing the Bullying Report form.
The Bullying Report form can be submitted anonymously. If you wish to remain anonymous, leave the name and email fields blank. No disciplinary action will be taken solely on the basis of an anonymous report.
DEFINITION OF BULLYING:
A. Bullying (includes Cyberbullying and Bullying of a sexual nature): Any severe or pervasive physical or verbal act or conduct, including communications made in writing or electronically, directed toward a student or students that has or can be reasonably predicted to have the effect of one or more of the following:
1. placing the student or students in reasonable fear of harm to the student’s or students’ person or property;
2. causing a substantially detrimental effect on the student’s or students’ physical or mental health;
3. substantially interfering with the student’s or students’ academic performance; or
4. substantially interfering with the student’s or students’ ability to participate in or benefit from the services, activities, or privileges provided by a school. Bullying may take various forms, including without limitation one or more of the following 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. This list is meant to be illustrative and not exhaustive.
B. Cyberbullying: bullying through the use of technology or any electronic communication, including but not limited to, electronic mail, Internet communications, and instant messages. Cyberbullying includes the creation of a webpage or blog in which the creator assumes the identity of another person or the knowing impersonation of another person as the author of posted content or messages if the creation or impersonation creates any of the effects enumerated in the definition of bullying. Cyberbullying also includes the distribution by electronic means of a communication to more than one person or the posting of material on an electronic medium that may be accessed by one or more persons if the distribution or posting creates any of the effects enumerated in the definition of bullying.
C. Retaliation: any form of intimidation, reprisal including but not limited to the submission of knowingly false bullying allegations, or harassment directed against a student who reports bullying, provides information during an investigation, witnesses, or has reliable information about bullying.
Name of person reporting:
Campus where bullying incident allegedly occurred:
Name of student(s) who is the target of the bullying:
Incident Summary - Please provide a description of the alleged bullying incident as clearly as possible.
Aggressor(s) - Please identify the name(s) of the student(s) who is the aggressor in the bullying incident.
Other Witnesses - If not stated in the incident summary, please provide the names of the other students or people who have witnessed the bullying occur.
Never submit passwords through Google Forms.
This form was created inside of Acero Charter School Network.