Bully Reporting-Westerly High School
Your Name (optional, but helpful):
I am a:
Describe the situation:(include info on the bullly, victim, any witnesses/bystanders; the more detail you provide the better)
Select the statement(s) that you believe best describe what happened. (choose all that apply)
Involves physical aggression.
Making rude and/or threatening gestures.
Pattern of excluding or rejecting a student.
Intimidating (bullying) and/or extorting.
Threats and/or retaliation
Spreading harmful rumors/gossip
Electronic Communications used to bully (select all that apply):
Harassment (select all that apply)
Location(s) (select all that apply):
Date and Time this happened:
Have you told anyone else about this incident? Who?
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This form was created inside of Westerly Public Schools.