Bullying Report Submission Form
WHEN TRYING TO DETERMINE IF AN INCIDENT IS HIB, COMPARE IT AGAINST THE DEFINITION.

DOES THE INCIDENT MEET ALL OF THE FOLLOWING?

Harassment, Intimidation, or Bullying means any gesture; any written, verbal or physical act; or any electronic communications, whether it be a single incident or a series of incidents that:

... is reasonably perceived as being motivated by any actual or perceived characteristic, such as race, color, religion, ancestry, national origin, gender, sexual orientation, gender identity and expression, or a mental, physical, or sensory disability; or by any other distinguishing characteristic; and that

... takes place on school property, at any school sponsored function, on a school bus, or off school grounds, as provided for in N.J.S.A. 37-15.3; and that

... substantially disrupts or interferes with the orderly operation of the school or the rights of other students.

AND, DOES IT MEET ONE OF THESE?

... A reasonable person should know, under the circumstances, that the act(s) will have the effect of physically or emotionally harming a student or damaging the student’s property, or placing a student in reasonable fear of physical or emotional harm to his/her person or damage to his/her property

... Has the effect of insulting or demeaning any student or group of students

... Creates a hostile educational environment for the student by interfering with a student’s education or by severely or pervasively causing physical or emotional harm to the student


If the incident meets the criteria noted above, please complete the form below.

If the incident does not meet the criteria above, or if you are not certain if it meets the criteria, please contact the appropriate building principal to discuss your concern.

Name of person doing the bullying. *
Your answer
Name of the person being bullied. *
Your answer
Location where bullying incident occurred. *
Your answer
Describe the bullying incident. *
Your answer
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