Student Bullying Report
Bullying is negative acts that is done on purpose and involves an imbalance of power. Bullying is not a one time action, but it is repeated over time.
First and last name of victim (who is getting bullied) *
Grade of victim *
First and last name of the alleged bully (who is alleged offender) *
Grade of alleged bully *
Name of any witnesses (who saw this happen to you) *
Who is reporting this information? (Who is completing this form) *
Dates of incidents (What dates did it happen?) *
Where did the incident occur (check all that apply) *
Which statement(s) best describe what happened? (check all that apply) *
Please provide details about the situation *
How many times has the incident occurred or the alleged bully done something to the victim? *
Have you told anyone about the bullying? (check all that apply) *
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