Complete the below questions in as much detail as possible. Include name(s) of individuals involved, date(s) the incident took place, the location(s) of the incident as well as a description of the incident.
Name of School
Henry Harris School
Philip G. Vroom School
Walter F. Robinson School
Mary J. Donohoe School
Lincoln Community School
Horace Mann School
William Shemin Midtown Community School
Washington Community School
Woodrow Wilson Community School
John M. Bailey School
Nicholas Oresko School
Bayonne High School
Name of person making this report
Relationship to the person making this report:
Parent / Guardian
Name of target AND grade Level AND student ID #
Name of alleged offender(s) AND grade level AND student ID #
List any witnesses to this incident and include their grade level
Date of incident
Approximate time the incident occurred
Where did the incident occur?
On school property
At a school sponsored activity or event off school property
Check which best describes he alleged harassment, intimidation, and/or bullying (HIB) behavior the target was subjected to:
Harassing phone calls or text messages
Teasing about appearance
Identify what harm you believe was or may have been cause by the alleged incident. Check all that apply.
Substantial disruption or interference with the orderly operation of school
Substantial disruption or interference with the rights of others
Insulting or demeaning a student or group of students
Creating a hostile education environment
Page 1 of 3
Never submit passwords through Google Forms.
This form was created inside of Bboed.org.