Bullying Report Form
Bullying occurs when a student or group of students engages in written or verbal expression, expression through electronic methods, or physical conduct against another student. For bullying to be addressed by the school, it must occur on school property, at a school-sponsored or school-related activity, or in a district-operated vehicle, and the behavior:
-- Results in harm to the student or the student's property,
-- Places a student in reasonable fear of physical harm or of damage to the student's property, or
-- Is so severe, persistent, and pervasive that it creates an intimidating, threatening, or abusive educational environment.
Date of the Incident *
MM
/
DD
/
YYYY
Time of the Incident *
Time
:
Location of the Incident *
Your answer
What type of bullying occurred? *
Required
Victim's Name and Grade (If you do not know the grade level, please provide the campus.) *
Your answer
Name of the Person(s) Doing the Bullying (If you do not know their name, then provide a detailed description of them.) *
Your answer
Description of the Event (This can be what happened to you if you were the one being bullied or what you witnessed from someone else being bullied. Try to provide as much detail as possible.) *
Your answer
Are there any witnesses of the bullying? If so, please provide their names.
Your answer
How did you become aware of the incident? *
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