BES Bullying/Threat/Discrimination Reporting

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Board Policy 7:20 Harassment of Students Prohibited

No person, including a School District employee or agent, or student, shall harass, intimidate, or bully a student on the basis of actual or perceived: race; color; national origin; military status; unfavorable discharge status from military service; sex; sexual orientation; gender identity[1]; gender-related identity or expression; ancestry; age; religion; physical or mental disability; order of protection status; status of being homeless; actual or potential marital or parental status, including pregnancy; association with a person or group with one or more of the aforementioned actual or perceived characteristics; or any other distinguishing characteristic. The District will not tolerate harassing, intimidating conduct, or bullying whether verbal, physical, sexual, or visual, that affects the tangible benefits of education, that unreasonably interferes with a student’s educational performance, or that creates an intimidating, hostile, or offensive educational environment. Examples of prohibited conduct include name-calling, using derogatory slurs, stalking, sexual violence, causing psychological harm, threatening or causing physical harm, threatening or actual destruction of property, or wearing or possessing items depicting or implying hatred or prejudice of one of the characteristics stated above.

Name and Email *

The Person Submitting This Report Is: *

Student

Student Witness

Parent/Guardian

School Personnel

Other:

Type of Behavior-What did they do? *

Cyber/Electronic Media (Internet Website Posting, chat room, video)

Social (Excluding, intimidation, telling lies/rumors, taunting)

Physical (hitting, pushing, stealing, stalking)

Verbal (calling names, threatening, demeaning comments)

Required

What day did it happen? *

YYYY

What time did it happen? *

Time

Where did it happen? *

Classroom

Locker Room

Hallway

Gymnasium

Lunchroom

Restroom

On Bus/At Bus Stop

Text/Phone/Internet/Social Media

Other:

Required

Who was the target? *

Do you believe the incident racially motivated? *

Yes

Describe, in as much detail as possible, the specifics of this incident. *

Witnesses-Who saw what happened? *

Response - What did you do (if anything) in response to the incident?
*

Have you contacted the school administration, teacher, or adult at the school? *

Yes

As a result of the incident, would you like to speak with a social worker or school counselor? *

Yes

Submit

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This form was created inside of Beecher School District 200U. Report Abuse

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