West Elk Schools Bullying Report Form
What is bullying?

Bullying is aggressive behavior that is intentional and that involves an imbalance of power or strength. Typically, it is repeated over time. A child who is being bullied has a hard time defending himself or herself. Bullying can take many forms, such as:

Hitting or punching (physical bullying).
Teasing or name-calling (verbal bullying).
Intimidation using gestures or social exclusion (nonverbal bullying or emotional bullying).
Sending insulting messages by email (cyberbullying).
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Email *
Your Name *
Relationship to Victim *
Date of Incident *
MM
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DD
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Type of Bullying (see descriptions above): *
Required
Who was Bullied? (Please list first and last names of all students, if reporting multiple students.) *
Who did the Bullying? (Please list first and last names of all students, if reporting multiple students.) *
Were there any bystanders? If yes, please list first and last name.
Where did it happen? *
Time of day? *
Has this happened before? *
Briefly describe the incident. *
Any other information we need to know?
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