Anonymous Report Submission Form
This form is meant to be used as a method to report threats, harassment, intimidation, bullying or any other instance which causes harm or potential harm to others.  

Students may report bullying to teachers or other school staff, the social worker, guidance counselors or to school administrators. There are also two ways of reporting bullying anonymously: 1)  Online form located on this page or  2) place a note in any administrator, counselor or teachers mailbox in the main office area. Parents or guardians of students may also report suspected bullying with an administrator or through this form. Any teachers or other school staff who witness acts of bullying or who receive student reports of bullying shall notify school administrators promptly of such acts. All reports of suspected bullying shall remain confidential.

Upon receipt of any of the foregoing reports, an administrator shall investigate within 24 hours the receipt of such reports. In the event that the administrator believes there is reason to suspect that bullying has occurred, he or she shall follow general student discipline procedures.

Reporting bullying is the responsible thing to do!



Definition of bullying:

Harassment, intimidation or bullying, "means any gesture, any written, verbal or physical act, or any electronic communication, whether it be a single incident or a series of incidents, that is reasonably perceived as being motivated either by any actual or perceived characteristic, such as race, color, religion, ancestry, national origin, gender, sexual orientation, gender identity and expression, or a mental, physical or sensory [handicap] disability, or by any other distinguishing characteristic, that takes place on school property, at any school-sponsored function [or], on a school bus, or off school grounds as provided for in section 16 of P.L.2010, CHAPTER 122, that substantially disrupts or interferes with the orderly operation of the school or the rights of other students and that:
a) a reasonable person should know, under the circumstances, will have the effect of physically or emotionally harming a student or damaging the student's property, or placing a student in reasonable fear of physical or emotional harm to his person or damage to his property; [or]
b) has the effect of insulting or demeaning any student or group of students [in such a way as to cause substantial disruption in, or substantial interference with, the orderly operation of the school]; or
c) creates a hostile educational environment for the student by interfering with a student’s education or by severely or pervasively causing physical or emotional harm to the student."

Examples may include:  

Someone is threatening to beat you up in school, including when walking to or from school, when you get off the bus, while talking to you on your cell phone or while you are online.

Someone is taking something of yours without your permission.

Someone is spreading rumors about you or your family.

Someone is embarrassing you in front of others by either calling you names or doing something to you like hiding your books, pulling your seat out from under you, etc.

Someone is telling other kids not to talk to you or be friends with you.
 
Someone continues to shove into you in the halls and says it is always an accident.
 
Someone is sexually harassing you. (following you around, whistling at you, making comments about your body or doing something to your body, touching you inappropriately, etc.)

Sign in to Google to save your progress. Learn more
Submitted by:
(Optional)
Victim's Name: *
Please select the school that the victim attends: *
Location where the incident occurred *
Describe the incident *
Please provide as much detail as possible. If you do not wish this to be anonymous, please include your name and relationship to the victim)
                                        *** WARNING FOR FALSE REPORTING ***
Any person found violating the usage terms of this reporting system will be found via an IP address and disciplined according to school policies and/or reported to the NJ State Police Cyber Crimes Unit.  Reporting a false claim is the same as if a claim had actually occurred and student/parents should be aware that the passage of NJ state law PL2010 requires strict penalties for not only those who commit acts of HIB but also those who create false claims against others.    

Please only use this service as a means to communicate serious instances of harassment, bullying and intimidation and/or other instances that may cause harm to other.  All submissions will be taken seriously and addressed within a 24 hour  time period.  
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Woodstown-Pilesgrove Regional School District. Report Abuse