Stonington Public Schools Electronic Bullying Form
This form is to report alleged bullying behavior that occurred in the current school year in any of the following locations; on school property, at school sponsored activity or on a school bus. Please complete this form - when complete, it will be forwarded to the building principal.
In order for behavior to be considered bullying it has to be (A) the repeated use by one or more students of a written, oral, or electronic communication, such as cyber bullying, directed at or referring to another student attending school in the same school district, or (B) a physical act or gesture by one or more students repeatedly directed at another student attending school in the same school district, that; (1) Causes physical or emotional harm to such student or damage to such student's property, (2) places such student in reasonable fear of harm to himself or herself, or damage to his or her property, (3) creates a hostile environment at school for such student, (4) infringes on the rights of such student at school, or (5) substantially disrupts the education process or the orderly operation of a school.
OPTIONAL: You do not have to give your name when reporting an incident, however, you must be aware that without your name, school personnel will not have a way to contact you or talk with you in confidence. Your privacy will be respected. False reports and/or accusations will be dealt with harshly.
Person being bullied
I have reported this incident to an adult.
If yes, whom did you report it to?
Name of person being bullied:
Where did this happen?
When did the incidents occur?
Name of the person(s) doing the bullying hehavior:
Type of bullying behavior:
Choose the best description
Excluding from activities
Teasing in a hurtful way
Did anyone else see this happen?
If yes, please put include their name
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This form was created inside of Stonington Public Schools.