Sleepy Eye High School Bullying Report Form
ISD 84 maintains a firm policy prohibiting all forms of bullying. All persons are to be treated with respect and dignity. Bullying by any pupil, teacher, administrator or other school personnel who creates an intimidating environment will not be tolerated under any circumstances.

Bullying means any written or verbal expression, physical actor or gesture, or intentional electronic communication by an individual that is intended to cause or is perceived as causing distress to another and which substantially interferes with another’s educational benefits, opportunities, and/or performance on school property, at a school sponsored event or on the bus. Bullying includes, but is not limited to, conduct by an individual or group that a reasonable person under the circumstances knows or should know has the effect of: 1. harming someone, 2. damaging of someone’s property. 3. Placing someone in reasonable fear or harm to person or property. 4. Creating a hostile educational environment. 5. Intimidating someone.

Your Name:
Your answer
Today's Date:
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Name of victim:
Your answer
Name of alleged offender:
Your answer
Witnesses or Bystanders:
Your answer
What date(s) did the incident happen?
Your answer
Have you submitted a bullying report for this issue before?
This happens/happened:
Where did the incident happen? (Check all that apply)
If the incident happened on school property, where specifically?
Your answer
Nature of bullying being reported (check all that apply)
What did the alleged offender(s) say or do?
Your answer
What resources/tools have you used so far to handle this specific situation? (Check all that apply)
I am submitting this form based on my belief that ____________ bullied me or another person. I am reporting this because I am concerned and I want the situation to be better in the future.
Your answer
By submitting this form I certify that the information I have provided in this complaint is true, correct, and complete to the best of my knowledge and belief.
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