RSU 63 Bullying/Harassment Concern Report
If you are concerned about incidents of bullying or harassment, you can file an anonymous report using this survey. The information you submit will be sent to the school principal and school counselor.

Harassment is unwanted, one-sided and/or demeaning remarks or contact after being asked to STOP.
Examples of prohibited harassment:
1. Sexual advances, gestures, comments or contact
2. Threats
3. Offensive jokes
4. Ridicule, slurs, derogatory action or remarks regarding race, skin color, religion, ancestry, national origin, gender, sexual orientation or mental, physical or sensory handicap or other distinguishing characteristics

Bullying is defined as any physical act or gesture or any verbally, written or electronically communicated expression that a reasonable person should expect will have the effect of:
1. Physically harming a student or damaging student property
2. Places a student in reasonable fear of physical harm or damage to property
3. Ridicule, slurs, derogatory action or remarks regarding race, skin color, religion, ancestry, national origin, gender, sexual orientation or mental, physical or sensory handicap or other distinguishing characteristics.
4. Substantially disrupts the instructional program or the orderly operations of school: or
5. Is so severe, persistent or pervasive that it creates an intimidating, hostile educational environment for the student who is bullied.

Your Name (Optional. If you want us to follow up with you, please include your name.)
Your answer
Location of Incident(s)
Name and Grade of Student Bullying/Harassing
Your answer
Name Grade of Student Being Bullied/Harassed
Your answer
What is happening? Please refer to the bullying and harassment definitions above.
Your answer
Additional Information: Names, dates, specific locations, etc would be helpful. The more detailed information we have, the more we can do.
Your answer
Submit
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