Bullying Report Form
Bullying is any unwanted aggressive behavior(s) carried out by student(s) who are not siblings or current dating partners, involving an observed or perceived power imbalance. These behaviors are likely repeated, and target a victim based upon one or more distinguishing characteristics.
Email *
Date of the Incident *
Name of the Victim(s) *
Name of the Aggressor(s) *
Type of Bullying *
Reason you believe the victim was targeted. *
Describe the Incident *
What evidence will support this report *
Please list potential witnesses
Is this the first incident?
Clear selection
If no, how many times has it happened before?
Has this incident been reported to the police? *
Who is submitting this form, what is the best method for administration to contact you?
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