BCUSD#8: Bullying, Harassment or Intimidation Incident Report Form
Bullying, harassment, and intimidation are serious and will not be tolerated. This is a form to report alleged bullying harassment, or intimidation that occurred during the current school year on school property, at a school-sponsored activity or event off school property, on a school bus, on the way to and/or from school, or on the internet-sent on or off school property; or that substantially disrupted the orderly operation of the school. Bullying, harassment and intimidation includes any intentional conduct, including verbal, physical or written conduct, or an intentional electronic communication, that creates a hostile educational environment by substantially interfering with a student’s educational benefits, opportunities or performance, or with a student’s physical or psychological well-being.
1. Bullying – A pattern or behavior when a person repeatedly uses power in an intentional manner, including verbal, physical, or written conduct or intentional electronic communication against one or more students.
2. Cyberbullying –The use of electronic communication to harm or harass others in a deliberate, repeated, and hostile manner.
3. Harassment – Includes actual or perceived negative actions that offend, ridicule, or demean another individual with regard to race, national origin, marital status, sex, sexual orientation, gender identity, religion, ancestry, physical attributes, socioeconomic status, familial status, physical or mental ability, or disability.
4. Intimidation – subjecting an individual to intentional action that seriously threatens and induces a sense of fear and/or inferiority.
You have the right to complete this form anonymously. However, it will be easier for the District to investigate this matter if as much information as possible is provided. Submission of a good faith complaint or report of bullying will not affect the complainant or reporter’s future employment, grades, learning, or working environment. A complainant that falsely accuses someone will be subject to disciplinary action.
If you are a student, the parent/guardian of a student, a close adult relative of a student, or a school staff member and wish to report an incident of alleged bullying harassment, or intimidation, complete this form and return it to the principal at the student victim’s school. You may contact the school for additional information or assistance at any time.
Your Last Name:
Your First Name:
Date of completion of form:
School where alleged incident(s) are occurring:
Trimpe Middle School
Civic Memorial High School
Never submit passwords through Google Forms.
This form was created inside of Bethalto Comm Unit Sch Dist 8.
Terms of Service