Threatening Behavior Reporting Form
Examples include, but are not limited to:
 Verbal: Name-calling, teasing, inappropriate sexual comments, taunting, and threatening to cause harm.
 Social: Spreading rumors about someone, excluding others on purpose, telling other students not to be friends with someone, and embarrassing someone in public.
 Physical: Hitting, punching, shoving, kicking, pinching, spitting, tripping, pushing and taking or breaking someone’s things.

Resources:
What Teens Can Do https://www.stopbullying.gov/resources/teens
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Please check the type(s) of bullying you are reporting.
Name of student being bullied *
Who was bullying, harassing, intimidating or causing harm? (Please include first name, last name and grade if possible.) *
Name(s) of witnesses
When it happened (if during a specific period please include in "other": *
Required
Which school? *
Where it happened: *
Required
What Happened? Give as much information as you can. Let us know if there were any witnesses.: *
Name of reporter (you can choose to remain anonymous) *
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