Bullying/Harassment Incident Reporting Form

The Central Community School District is committed to providing all students and staff with a safe environment in which all members of the school community are treated in a caring manner, as defined by our PBIS expectations: Caring Commitment and Safety.

Bullying/harassment does not allow students or staff to feel safe. Bullying, as defined by Iowa law, must fit these three criteria: aggressive, repeated, and have an imbalance of power. It may be electronic, written, verbal, or a physical behavior that includes
*fear of harm to self or property
*has a negative effect on physical or mental health
*has a negative effect on academic performance
*may interfere with participation on school activities or events.

If you feel that you have been bullied, please complete this form immediately.

The counselor will review it and respond to you within 24 hours.


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