REPORT BULLYING NOW

If you or someone you know has been the victim of bullying please report it on the form below. The definition below outlines what exactly bullying can be:

What is "Bullying"?
This means 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, by electronic means (cyberbullying), or physical conduct.

Where can "Bullying" take place?
It can occur on school property, at a school-sponsored event or school-related activity, or in a vehicle operated by the
district.

What effects can "Bullying" have on a student?
This involves physically harming a student, causing a student to experience substantial negative mental health
effects, 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; or is sufficiently severe, persistent, and pervasive enough that the action or threat creates an intimidating, threatening, or abusive educational environment for a student.

What can the impact of "Bullying" be?
It can 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.

1. What campus do you attend? *

2. What is the name of the alleged victim(s), or your name?

Your answer

3. What is the name(s) of the alleged person(s) doing the bullying? *

Your answer

4. What is the name of the witness(es), you can put none if there was not any?

Your answer

5. When did this incident take place? *

YYYY

Time

6. Where did this incident take place? *

7. Which of these best describes what type of alleged bullying you experienced? *

Physical: hitting, pushing, shoving, slapping, kicking, spitting, beating up, or having property stolen

Threats: promising to cause physical harm to at a later time

Verbal: called names, teased hurtfully, insulted, humiliated, or threatened

Social: excluded from a group, made to look dumb by someone, gossiped about; rumors spread

Electronic: threatened, embarrassed, singled out, had feelings hurt, been gossiped about, or had secrets about you revealed through e-mail/text messages/pictures

Ethnic: treated differently or badly because of your race, culture, ethnic

Gender: left out or treated badly because you are a boy or a girl; heard sexist comments

Adult Oriented: incident involving an adult

Other:

8. Describe in detail, what allegedly happened to you or the person who was being bullied? *

Your answer

9. Is this the first time you(your friend) has been bullied by this person(s)? *

Yes

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