Sebeka School - Bullying Report 2021-2022
The person REPORTING the bullying incident has the option of including his or her name on this form OR submitting the form anonymously. Anonymous reports are more difficult to investigate.

According to our School Board policy as found in our school's handbook, “Bullying” means intimidating, threatening, abusive, or harming conduct that is objectively offensive and:

1. an actual or perceived imbalance of power exists between the student engaging in the prohibited conduct and the target of the prohibited conduct, and the conduct is repeated or forms a pattern; or

2. materially and substantially interferes with a student’s educational opportunities or performance or ability to participate in school functions or activities or receive school benefits, services, or privileges.

Please answer all sections that apply and submit this form. It will, according to MN state law, be investigated within three school days.

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Are you a: *
Required
Your Name (optional)
Date & time of the incident *
Location of the incident (hallway, playground, etc.) *
Person or persons doing the bullying *
Name/grade of the person who was the victim, if not you: *
If you were not the victim, how did you learn about the alleged bullying incident? *
Describe what took place, such as the type of bullying (verbal, written, or online), and any other important information. *
Name/names of anyone else who witnessed the incident:
This report is filed based on my honest belief that ____________________ has bullied or was violent to another person or me. I certify this information is true and complete to the best of my knowledge *
Clicking submit at the end of this report confirms this statement.
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