Anonymous Student Bullying Report Form
Bullying is defined as unwanted, aggressive behavior that includes verbal, cyber, physical, or social behavior that is REPEATED over a period of time. Bullying is NOT peer conflict (arguments or disagreements), fighting, horseplay, hazing, or similar behavior that has happened only once or twice. If the behavior you want to report fits the definition of bullying, please answer the questions below and submit the form. This is an anonymous form and the sender's identity will not be known.
What is the name of the person(s) doing the bullying?
What is the name of the person(s) being bullied?
What type of bullying is taking place? (Check all that apply)
A. Physical (hitting, kicking, breaking the person's personal belongings, etc.)
B. Verbal (hurtful comments, teasing, threats, etc.)
C. Social (spreading rumors, excluding, telling others not to speak to or sit with the person)
D. Cyber (rude or hurtful comments on social media, mean text messages, prank calls, etc.)
Please describe the bullying activity or behavior below. Please give as many details as possible.
How long has the bullying been going on?
Where does the bullying mostly take place? (School, online/social media, bus, off school grounds)
When or what time does the bullying usually take place?
Have you reported this activity to a school staff member before? If so, who did you report it to and when?
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