Report for Bullying, Self-Harm, or Other Non-Academic Issues

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Examples of bullying: hazing, threats, taunting, teasing, assault, demands for money, theft, name calling, ostracism, rumor spreading. This includes in person and cyberbullying - both on and off campus.

NOTE: If you have been a victim or know of a friend who needs help, you can anonymously report it here. If you have a concern with a student or staff member regarding drugs or alcohol you can anonymously report here.

On what date did the bullying happen? *

When did the bullying happen? (Select All That Apply) *

Before School

During the School Day

After School

On a Weekend or Other Day Off From School

Other:

Required

Where did the bullying happen? *

On the walk or bus ride between school and home.

On the playground.

In the bathroom at school.

In the hallway at school.

In the cafeteria.

In the gym.

In the classroom.

Cell phone or text message.

Facebook, Twitter, or other IM or Internet Site

Other

Required

Did anyone try to stop the incident when it was happening? *

Yes

Not Sure

Required

If you answered yes to the above question, can you please describe what happened to try to stop the incident.

The word "target" means the person who was bullied. The word "aggressor" means the person who was doing the bullying. The word "bystander" means people who might have seen or heard the incident as it was happening. This might be someone who saw a fight, read something on Facebook, or saw a text between two people. There is often more than one target and one aggressor involved in bullying incidents.

Please give us as much information as you can about all of the people involved. *

Names of anyone who may have witnessed the incident, including staff, or other students.

Please share the first and last name of at least one of the student(s) who were the targets of the bullying. If you don't know the student's full name, please put as much as you know here. *

Please share the first and last name of at least one of the student(s) who were the aggressors, or the bullies. If you don't know the student's full name, please put as much as you know here. *

Do you know of any bullying that has happened between these people before this incident? *

Yes

Not Sure

Required

How did you find out about this incident? (Check All That Apply) *

I was involved in the incident.

I was a witness to the incident.

I am the parent / guardian of a student involved.

I am a teacher, staff, or volunteer who was told about the bullying by someone else.

I am a student who was told about the bullying by someone else.

Other:

Required

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