CHS 2023-2024 Student Bullying Report Form
Student Bullying Report Form

Definition of bullying:  an overt, unwanted, repeated act or gesture, including written or verbal communications or images transmitted in any manner, physical acts, or any other behaviors that are committed by a student or group of students against another student with the intent to harass, ridicule, humiliate, intimidate, or harm the other targeted student and create for the targeted student an objectively hostile school environment.
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Person Reporting Bullying
I'd like this report to be anonymous
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You are: *
Today's date *
Name of person you think was bullied? *
What school does the person attend? *
When did the bullying happen? *
Who do you think was bullying? *
Type of Bullying (check all that apply) *
Where did the bullying happen?  (check all that apply) *
Is this the first time that this has occurred: *
Have you filed a Student Bullying Report before? *
Who has been told about the incident or saw what happened?  (check all that apply) *
Names of possible witnesses *
Any other information that you would like to share *
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