Bullying/Cyberbullying Report
Fredericktown R-1 School District Board Policy 2023-24

In accordance with state law, bullying is defined as intimidation, unwanted aggressive behavior, or harassment that is repetitive or is substantially likely to be repeated and causes a reasonable student to fear for his or her physical safety or property; that substantially interferes with the educational performance, opportunities or benefits of any student without exception; or that substantially disrupts the orderly operation of the school. Bullying includes, but is not limited to: physical actions, including violence, gestures, theft, or property damage; oral, written, or electronic communication, including name calling, put downs, extortion, or threats of reprisal or retaliation for reporting such acts.

A form of bullying committed by transmission of a communication including, but not limited to, a message, test, sound, or image by means of an electronic device including, but not limited to, a telephone or other wireless communication device, computer or pager. The district has jurisdiction over cyber bullying that uses the district's technology resources or that originates on district property, at a district activity or on district transportation. Even when cyber bullying does not involve district property, activities or technology resources, the district will impose consequences and discipline for those who engage in cyber bullying if there is a sufficient nexus to the educational environment, the behavior materially and substantially disrupts the educational environment, the communication involves a threat as defined by law, or the district is otherwise allowed by law to address the behavior.
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Email *
Date Filed:  *
1. I prefer to remain anonymous (the district will investigate all allegations of bullying, but it is more difficult to follow up on anonymous reports). *
2. Name of Individual Filing Report:   *
3. Description of Reporter *
4. Address of reporter:
5. Phone number and email of reporter:
6. Name of Potential Target:   *
7. Name of Potential Perpetrator:  *
8. Name of Potential Witnesses:  
9. Estimated Date of Occurrence:   *
10. Check all that apply *
11. Target's Grade Level: *
12. Perpetrator's Grade Level: *
13. What type of incident occured? *
14. In what setting did the incident occur? *
15. Did you witness this incident? *
16. If you did not witness the incident, provide specific information as to how you found out about this incident:
17. Have you reported this to anyone else: *
18. If you answered YES to the above question, please state who you reported the incident to and when.  
19. Please describe the incident.  (Include as much detail as possible.  Do not "clean up" anything that was said or done.  If inappropriate language or gestures were used, include the exact language and describe the exact gesture used)  
20. If there any other information you believe is relevant for the district to know when investigating this incident?  
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