SCS Formal Bullying Reporting Form

Statement of Understanding: I acknowledge that by submitting this report I understand that harassment, bullying, and intimidation is defined by the Ohio Revised Code as "intentional written, verbal, graphic, physical or electronic acts that a student or group of students exhibited toward the alleged victim more than once; and the behavior both causes mental and physical harm to the other student, and is sufficiently severe, persistent or pervasive that it creates an intimidating, threatening or abusive educational environment for the the other student (ORC 3313.666).

(Do we have anything in our handbooks about false reporting?) How do we want to document that false reporting could result in disciplinary actions?

By checking this box you are acknowledging the statement above and understand that the Struthers City School will address all Bullying Claims as well as False Reports. *

Yes

Required

Person completing this form is: *

Name of Alleged Victim

Your answer

Grade Level *

Name of Alleged Offender *

Your answer

Grade of Alleged Offender *

If there is more than one Alleged Offender please list all names and grades below.

Your answer

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