Speak Up to Stop Bullying - Roberts Elementary

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Brazosport ISD seeks to empower students to take personal responsibility for eliminating bullying, including cyberbullying, within our schools and community. It is important for students to report bullying and cyberbullying when they observe or experience it as soon as possible, so school officials may take appropriate action. Parents, staff members, and community members who learn of bullying or cyberbullying incidents are also asked to report it as soon as possible, in support of a community-wide stance against this type of behavior.

Reports may be made by completing and submitting this form. Reports may also be made by calling the B*SAFE Hotline at 979.730.SAFE (7233) or by directly contacting a campus administrator. Eliminating bullying behavior is everyone's responsibility, and your involvement is appreciated.

Date of incident

YYYY

Name of the person bullying

Grade of the person bullying

Kdgn

PreK

Unknown

Other:

Clear selection

Name of the person being bullied

Grade of the person being bullied

Unknown

Clear selection

Name(s) of bystanders and witnesses

Type of bullying

Cyberbullying

Damage to student's property

Physical

Verbal

Written

Clear selection

Location of bullying

Bus

Bus Stop

Cafeteria

Cellphone, Computer, or Internet

Classroom

Gym

Hallway

Locker Room

On the way to or from school

Parking lot

Playground

Restroom

School Event

Other:

Clear selection

Describe what happened. Give as many details as possible.

List evidence of bullying (photos, text messages, internet postings, etc.)

Your name (reports may be made anonymously)

Your contact information (optional)

Select the response that best describes you.

Student

Parent

Staff member

Community member

Other:

Clear selection

Submit

Clear form

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