Wellington ISD Bullying Form
Bullying (All Grade Levels)

Bullying is defined in Section 37.0832 of the Education Code as a single significant act or a pattern of acts by one or more students directed at another student that exploits an imbalance of power and involves engaging in written or verbal expression, expression through electronic means, or physical conduct that:

Has the effect or will have the effect of physically harming a student, damaging a student’s property; or placing a student in reasonable fear of harm to the student’s person or of damage to the student’s property;

Is sufficiently severe, persistent, or pervasive enough that the action or threat creates an intimidating, threatening, or abusive educational environment for a student;.

Materially and substantially disrupts the educational process or the orderly operation of a classroom or school; or

Infringes on the rights of the victim at school.

Bullying includes cyberbullying. Cyberbullying is defined by Section 37.0832 of the Education Code as bullying that is done through the use of any electronic communication device, including through the use of a cellular or other type of telephone, a computer, a camera, electronic mail, instant messaging, text messaging, a social media application, an Internet website, or any other Internet-based communication tool.

*By submitting this Complaint Form, you certify that all statements made in the complaint are true and complete. Any intentional misstatement of fact will subject you to appropriate disciplinary action. I authorize school officials to disclose the information I provide only as necessary in pursuing the investigation.
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1. Name of person completing this form: (optional)
2. Grade level of person completing this form: (Mark only one oval) *
3. List the name of student(s) accused of bullying: *
4. Relationship between you and the accused student: *
5. List the name of student(s) who is the victim of the bullying: *
6. Date(s) of incident: *
7. Type of bullying: (Mark only one oval) *
8. Please share as many details as you can about the bullying incident(s): *
9. Were there any other witnesses? (Mark only one oval) *
10. Has this been previously reported? (Mark only one oval) *
11. If so, to whom?
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