TCS Bullying Report Form
Directions: Bullying, harassment, or intimidation is serious and will not be tolerated. This is a form to report alleged bullying, harassment, or intimidation that occurred on school property, at a school-sponsored activity or school-sponsored event off of school property, or on a school bus in the current school year. If you are a student victim, the parent/guardian of a student victim, a close adult relative of a student victim, or a school staff member, and wish to report an incident of alleged bullying, harassment or intimidation, please complete this form.  Once complete, the results of this form will be sent to the principal at the student victim’s school.

This form will be monitored during the school year during school hours. Any reports submitted during holidays or outside of the school day, will be investigated during the following normally scheduled school day.  Please do not use this system for issues requiring immediate assistance.  If this is an emergency requiring immediate assistance, please call 911.  Contact the school directly for additional information or assistance during posted office hours.
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What Counts As Bullying?
Bullying is  any intentional and repeated  act of unwanted aggressive or demeaning behavior  involving a real or perceived power imbalance  that takes place on or off school property, in which one or more people intentionally and repeatedly cause physical or psychological harm to another person.  To be considered bullying, the conduct  must  also place a student in reasonable fear of harm or of damage to property, have the effect of substantially interfering with educational performance or school operation,  or  create a hostile, intimidating, threatening, or abusive educational environment.
Power Imbalance -  The incident(s) you are reporting involve a real or perceived power imbalance. *
Repetition - The incident(s) you are reporting involve *repeated* physical or psychological harm.

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Originating School - School where incident occurred *
Person Reporting Incident
Reporter Name - Enter the name of the person reporting the incident. (Smith, John) *
Reporter Phone *
Reporter Email Address - Please enter the email address for the person reporting *
Reporter Position - Please select the most appropriate role of the person reporting *
Alleged Student Victim
Alleged Victim Name - Please enter the name of the alleged student victim. (Smith, John) *
Alleged Victim Grade *
Alleged Offender
Alleged Offender Name - (Smith, John) Enter "Unknown" if not known. *
Alleged Offender School - Please select the school this offender attends, if known.  *
Alleged Offender Grade  - Enter grade if known. *
Alleged Offender Position - Please select the most appropriate role of the person reporting *
Incidents
Date of Incident #1 *
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YYYY
Date of Incident #2 *
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YYYY
Date of Incident #3
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YYYY
Location of Incidents - Check all that apply *
Required
Nature of Incidents - Check all that apply *
Required
Motive for Incidents - check all that apply *
Required
Physical - Did a physical injury result from this incident?  *
Psychological - Did a physiological injury result from this incident?  *
Psychological - Has the student made or reported any threat of suicide, or suicidal thoughts?  *
Suicide and Crisis Lifeline
If you or someone you know are feeling alone and having thoughts of suicide—whether or not you are in crisis—or know someone who is, don’t remain silent. Talk to someone you can trust through the 988 Suicide & Crisis Lifeline. 
Absences - Was the student victim absent from school as a result of the incident?  *
Additional Details - Share any additional information related to the incidents
Additional Information - Is there any additional information you would like to provide?
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