CFMS Bullying and Harassment Reporting Form
First and last name/ grade of student being bullied?
First and last name/ grade of individual behaving like a bully?
Where did this occur?
When did this occur (Date)
What time did this occur?
Type of bullying/harassment
Physical - Hitting, kicking, pushing, other physical aggression
Verbal - Teasing, name-calling, put-downs, other non-physical behavior that would hurt other's feelings or make them feel bad.
Emotional - Exclusion, starting rumors, telling others not to be friends with someone.
Cyber bullying - using social media/electronic device to engage in any previously mentioned bullying.
Please add any additional information that you need to share. Describe what you witnessed or what the student reported to you.
Have you reported the bullying to another adult at the school? If yes, please enter their name below.
Your Name (optional)
I am a ...
Did you witness the bullying?
Who else witnessed the event?
Email address (optional)
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