MGS Bullying Report Form

Metamora Grade School is committed to creating a safe and supportive learning environment for all students. School incidents involving bullying are taken very seriously at MGS. When these incidents are reported, support services can be provided to all students involved. This includes the student being bullied, the offender, or a bystander.
The Illinois legislature defines bullying as meaning: any severe or pervasive physical or verbal act or conduct, including communications made in writing or electronically, directed toward a student or students that has or can be reasonably predicted to have the effect of one or more of the following:
1. Placing the student or students in reasonable fear of harm to the student’s or students’ person
or property;
2. Causing a substantially detrimental effect on the student’s or students’ physical or mental
health;
3. Substantially interfering with the student’s or students’ academic performance; or
4. Substantially interfering with the student’s or students’ ability to participate in or benefit from the
services, activities, or privileges provided by a school.

This form has been created to help provide a safe means of reporting an incident of bullying to school personnel. It is designed to remain anonymous and it is encouraged that bystanders of bullying incidents report their observations so appropriate action can be taken. Victims of bullying are also encouraged to use this form as well as reporting the incident directly to the staff at MGS.

Thank you for taking the time to complete this form. MGS appreciates your help in maintaining a safe environment for our students.