Safe Space and Bullying Prevention Reporting Form SY25-26
BOSTON PUBLIC SCHOOLS - Succeed Boston @ the Counseling & Intervention Center
Email: saws@bostonpublicschools.org | Bullying Hotline: (617) 592-2378
NON-BPS Schools & charters in Boston: Call DESE at 781-338-3700.

Bullying is repeated, intentional, and occurs when there is an imbalance of power. Additional information available in the Massachusetts State Bullying Law.

Immediately: 
-Allegations are forwarded to School Leader/Designee
-If there is a safety concern, a safety/support plan must be developed & implemented by the School Leader/Designee

Within 24 hours of receipt:
 -School leader/designee contacts reporter & family/caregiver of alleged target and alleged aggressor to acknowledge receipt

Within 5 school days:
 -School leader/designee shares findings/recommendations for each student with their family/caregiver
 -Investigation form must be submitted to Succeed Boston

Please note: All reports and investigations involving bias-based speech, behavior, or sexual misconduct will be forwarded to the Office of Civil Rights by Succeed Boston.
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Name of the person reporting this bullying allegation. Write "NA" if you want to report anonymously. Note, no disciplinary action will be taken solely on the basis of an anonymous report. *
Who is reporting this bullying allegation? *
Name and email of person completing this form (if different than above): Write "NA" if not relevant.  *
Role of person completing this form (if different than above)
 *
Have you already reported this incident to the school leader?
 *
Name of alleged target: *
Student ID# of alleged target: (Please put 0 if unknown) *
School of alleged target: *
Grade of alleged target: *
Does the alleged target receive special education services?   *
Name and grade of the alleged aggressor(s): (If the alleged aggressor is an adult, please indicate) *
Do any alleged aggressor(s) attend a different school? If yes, please type the name of the school(s) below. (If not, please write "NA")
 *
Date, time, and location of incident(s): (If not known, please write "NA") *
If the incident occurred on a school bus, please list the bus number below: (If not on a bus, please write "NA") *
Describe the incident, including names, details of what happened, and specific words used. You may send additional evidence (i.e., video, screenshots, emails) to saws@bostonpublicschools.org. *
Witnesses: List the names of any people who saw the incident or may have information about it: (If none, please write "NA") *
Does this bullying allegation involve bias-based speech, behavior, and or sexual misconduct? This is when a person is bullied or harassed because of membership in, or perceived membership in, a protected class. Please note: If you selected yes, this will be forwarded to the Office of Civil Rights by Succeed Boston.
 *
Are you concerned for the student's safety? *
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