Bullying Form 2020-2021
(Bullying Incident Report Form for Use by Parents, Students, and Community Members)
Email address *
Reporter (Person Filing the Report)
*
PO Box 34 Bland, MO 65014
573-533-9161
Teacher *
I prefer to remain anonymous. *
Did you witness this incident?
Clear selection
The student who was bullied informed me that it had happened.
Details of Incident
My class was sitting outside reading a short story together. Gunner and Frankie were sitting at the other end of the picnic table than I was so I did not overhear any of their interaction. Gunner claims that Frankie was calling him "gay" and a "girl". When we came into the classroom, an interchanged took place between them. When I asked what was going on, Gunner said, "Frankie keeps call me gay and a girl." I took each boy outside to talk to them individually. Frankie admitted that he called Gunner a girl, but denied saying he was gay. He then said that Gunner was calling him stupid. Gunner denied saying that Frankie was stupid.
9-17-2020
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around 11:45 am
Time
:
The incident took place at the picnic tables in between the trailer and the middle school building.
Gunner Burns and possibly Frankie Turner
Gunner Burners
6th Grade
Gunner Burns
Grade Level / School of Attendance
Name of Targeted Student:
Grade Level / School of Attendance
Name of Targeted Student:
Grade Level / School of Attendance
Please provide as much of the following information as possible for each student who was engaging in the bullying behavior: Cameron Rhemert
Name of Subject of Report Cameron Rhemert
Grade Level / School of Attendance 5th grade
Name of Subject of Report
Grade Level / School of Attendance
Name of Subject of Report
Grade Level / School of Attendance
Name of Subject of Report
6th Grade/Bland Middle School
Bullying incident
Grade Level / School of Attendance
Name of Subject of Report
Grade Level / School of Attendance
List the names of others who witnessed or may have 6th Grade/4th hour Literature Class - Piper Marsee, Hank Willis, and Benjamin Tilton
see above information
These two students are not on friendly terms with each other. I continually hear Gunner comment to Frankie to stop doing something or saying something, but I have never heard what Frankie has said.
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