Roberts Middle School Bullying Reporting System
 Fred Roberts Middle School is committed to providing all students with a safe and civil environment in which all members of the school community are treated with dignity and respect. BULLYING IS SERIOUS AND WILL NOT BE TOLERATED.  Bullying occurs when a person is exposed, repeatedly and over time, to negative actions on the part of one or more other persons, and he or she has difficulty defending himself or herself. Bullying is aggressive behavior that involves unwanted, negative actions. Bullying involves a pattern of behavior repeated over time. Bullying involves an imbalance of power or strength.

Bullying is any electronic, written, verbal, or physical act toward a person which creates a hostile school environment that meets one or more of the following conditions:
 - Places the student in reasonable fear of personal harm or danger.
 - Has a significant negative effect on the student's physical or mental health.
 - Significantly interferes with a student's academic performance.
 - Significantly interferes with the student's ability to participate in or benefit from the services or activities provided by the school.

**Please Note** This form will be checked during school hours, not on weekends or holidays.
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Date of Incident *
Alleged Student Victim * *
First Name, Last Name, and Student ID#
Alleged Offender(s) (if known) *
First Name, Last Name, and Student ID#
 This incident was based on bullying behavior in the category listed below: * *
Choose all that apply:
Where did the incident happen? *
Choose all that apply:
Description of Incident *
Who have you reported this incident to? *
Choose all that apply:
Who are witnesses to the incident? *
I am a... *
Choose from the dropdown list
Name *
By placing my name in this box, I agree that all of the information on this form is accurate and true to the best of my knowledge. (If you wish to remain anonymous type None.)
Contact Information *
Address/Phone Number/etc.
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