Bullying Report Form
"Bullying" means any aggressive and unwanted behavior that is intended to harm, intimidate, or humiliate the victim; involves a real or perceived power imbalance between the aggressor or aggressors and victim; and is repeated over time or causes severe emotional trauma. "Bullying" includes cyber bullying. "Bullying" does not include ordinary teasing, horseplay, argument, or peer conflict.
Code of Virginia § 22.1-276.01.
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Student name who is repeatedly being bullied. *
Student name who is repeatedly doing the bullying. *
When did the repeated bullying incidents occur? *
Specific dates or how long repeated bullying has been going on.
Where did the repeated bullying incidences happen. *
Check all that apply
Type of bullying that occurred. *
Check all that apply
Description of repeated bullying incident(s). *
Witnesses (if any known)
All reporting will go to the confidential file of the school counselors.  After reviewing reports, appropriate school personnel will investigate and intervene appropriately based on determination of information gathered.
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