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 address *
Date of the Incident *
Your answer
Name of the Victim(s) *
Your answer
Name of the Aggressor(s) *
Your answer
Type of Bullying *
Reason you believe the victim was targeted. *
Your answer
Describe the Incident *
Your answer
What evidence will support this report *
Please list potential witnesses
Your answer
Is this the first incident?
If no, how many times has it happened before?
Your answer
Has this incident been reported to the police? *
Who is submitting this form, what is the best method for administration to contact you?
Your answer
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