College Bound Academy Anonymous Reporting Form - Bullying, Harassment, or Intimidation

  1. It is the policy of College Bound Academy to prohibit all bullying, harassment, or intimidation of any person at school. This policy shall extend to all schools in College Bound Academy school district. Prohibited conduct includes incidents of bullying, harassment, or intimidation instigated by use of electronic communication specifically directed towards a student or school personnel. 

  2. This Bullying, Harassment, or Intimidation reporting form should be used to report alleged incidents of bullying, harassment or intimidation that occur during the current school year. School staff will address incidents that occur at school or have a connection to the school setting that create a risk of harm to other students while they are at school or interfere with the educational environment.

    Definitions : 

      1. “At school” means on school grounds, in school vehicles, at school-sponsored activities, or at school-sanctioned events

      2. “Bullying” means any pattern of harassment, intimidation, threatening behavior, physical acts, verbal communication, or electronic communication directed toward a student or group of students that results in or is reasonably perceived as being done with the intent to cause negative educational or physical results for the targeted individual or group; and is communicated in such a way as to disrupt or interfere with the school’s educational mission or the education of any student. Any unwanted, demeaning behavior among students that involves a real or perceived power imbalance is also considered bullying. 

      3. “Cyberbullying” is bullying that takes place over digital devices like cell phones, computers, and tablets. Cyberbullying can occur through texting, apps, or online via social media, forums, or gaming, where people can view, participate in, or share content. Cyberbullying includes sending, posting, or sharing negative, harmful, false, or harmful content about another student. It can include sharing personal or private information about someone else causing embarrassment or humiliation

      4. “Harassment” includes actual or perceived negative actions that offend, ridicule, or demean another student with regard to race, ethnicity, national origin, immigration status, family/parental or marital status, sex, sexual orientation, gender identity, gender expression, religion, ancestry, physical attributes, socioeconomic status, physical or mental ability, or disability 

      5. “Intimidation” is any communication or action directed against another student that threatens or induces a sense of fear and/or inferiority. Retaliation may be considered a form of intimidation

      6. “Electronic communication” means the communication of any written, verbal, or pictorial information or video content by means of electronic device, including, but not limited to, a telephone, a mobile or cellular telephone or other wireless telecommunications device, or a computer

      7. “Threatening behavior” means any pattern of behavior or isolated action, whether or not it is directed at another person, that a reasonable person would believe indicates potential for future harm to students, school personnel, or school property

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Name, if you feel comfortable to provide it : 
Email, if you feel comfortable to provide it : 
Complainant(s) :  person or persons alleged to be the victim : 
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Respondent(s) : person or persons alleged to be the offender : 
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Alleged witness(es) :
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On what date or dates did the incident or incidents happen? 
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Where did the incident or incidents happen? 
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Required
If on school property, please specify where the incident or incidents happened : *
What statement best describes what happened? (check all that apply)
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Required
Did a physical injury result from this incident? 
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If there was a physical injury, do you believe there will be permanent effects on the student victim? 
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Was the victim absent from school as a result of the incident?
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If yes, how many days was the victim absent from school as a result of the incident?
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Did a psychological injury result from this incident? 
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Why do you think the incident or incidents occurred? 
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Please describe the incident. Give as much detail as possible : 
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Is there any additional information you would like to provide? 
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