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         "See Something, Say Something"                                      
If you have been the target of bullying or have witnessed the bullying of a District student, complete and submit this electronic form. (Paper forms are available at the school offices and required to be filled out in the office. Forms will not be handed out and a student sent away.)

Bullying Defined: Intimidation, unwanted aggressive behavior, or harassment that is repetitive or is substantially likely to be repeated and causes a reasonable student to fear for his or her physical safety or property.

Is It Bullying: *When someone says or does something unintentionally hurtful, and they do it once, that's RUDE.            
                        *When someone says or does something intentionally hurtful, and they do it once, that's MEAN.
                        *When someone says or does something intentionally hurtful and they keep doing it-even when you tell
                          them to stop or show them you're upset--that's BULLYING.

Reporters have the right to complete this form anonymously. However, it will be easier for the District to investigate this matter if as much information as possible is provided. Submission of a good faith complaint or report of bullying or harassment will not affect the complainant or reporter's future employment, grades, learning, or working environment. A complainant that falsely accuses someone will be subject to disciplinary action.
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Date Filed: *
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Your Name:
You are: *
Bullying is defined as "unwanted aggressive behavior that is repeated over time and involves an imbalance of power." Based on this definition do you believe you have experienced/witnessed bullying? *
Name of Student(s) subjected to Bullying: *
Date of Original Bullying Incident: *
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Time of Original Bullying Incident:
Time
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Date of Successive Bullying Incident: (Please Note: Bullying is repetitive or is substantially likely to be repeated.)
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Time of Successive Bullying Incident: (Please Note: Bullying is repetitive or is substantially likely to be repeated.)
Time
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Please provide a summary of the date and time to the best of your knowledge to aid in investigation.
Summarize the incidents or occurrences of bullying as accurately as possible. (The more detailed information that is provided will assist in the investigation process. ) *
Please give a detailed description of where the bullying is occurring. *
Names of all witnesses: *
Have you reported this to anyone else? *
If you have reported this to someone, who?
Please provide contact information for the ability of the district to follow up on this report. (Phone number, email, etc. ) (We may need additional information to investigate a claim fully so contact information is preferred. )
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