Bully/Safety Report Form
Please consider Indiana's definition of bullying when submitting a report:

“Bullying” means overt, unwanted, repeated acts or gestures, including verbal or written communications or images transmitted in any manner (including digitally or electronically), physical acts committed, aggression, or any other behaviors, that are committed by a student or group of students against another student with the intent to harass, ridicule, humiliate, intimidate, or harm the targeted student and create for the targeted student an objectively hostile school environment

NPUSC Bully/Safety Hotline  574-654-0471 or 219-778-1483
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Email *
Person Completing this Form *
Required
Which is your concern? *
Required
Email
School of Concern *
Required
Have you previously reported an incident involving this person? *
Required
If you have spoken to a school employee about this, please list whom.
Where did the incident happen? Please be specific, including dates, times, and location(s). *
Who are you, or someone you know, having problems with? *
Date of incident - As close as possible
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/
DD
/
YYYY
Please list any witnesses (first and last names)
Is this a repeated behavior? *
Required
Were you (or someone else) targeted? *
Required
Was the incident unprovoked? Was it one-sided (you didn't start it or say anything in retaliation)
How are you (or someone else) being harassed/intimidated or what type of incident is this?
Please explain the incident or safety concern below. Please be specific. *
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