Report Form

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Report Form

Our school does not tolerate bullying and takes all reports of bullying seriously. Consistent with Oak Park Elementary School District Board policies; bullying, intimidation, and harassment diminish a student’s ability to learn and a school’s ability to educate. Preventing students from engaging in these disruptive behaviors and providing all students equal access to a safe, non-hostile learning environment are important District goals. Bullying of any type should be reported immediately.

PLEASE NOTE: District 97 extends a special thank you to student Shawn C. for building the foundation for the bullying form. We would also like to thank our middle school students and administration team for their valuable feedback.

Names

We encourage you to include your name on this form (select "Other" and type your name), which will allow staff in your/your child's school to best aid in finding a resolution to this situation and follow up with you personally about next steps. However, if you choose not to include your name select "Anonymous" and an administrator will review the information and do their best to investigate (if appropriate) the situation described.

Name

Anonymous

Other:

Clear selection

Conflict v. Bullying

Conflict - A disagreement or difference of opinion between equals. When a conflict is poorly managed, it can result in aggression.

Bullying - When someone keeps being mean to someone on purpose. The person it’s happening to hasn’t been able to make it stop. It’s unfair and one-sided.

Is this bullying or conflict? *

Bullying

Conflict

Are you a ... *

Student

Parent

Teacher

Witness

Other:

School

Telling us your school (or the school of your child) helps direct this from to the correct principal. *

Grade Level *

What kind of behavior are you reporting? *

Harassment/Intimidation (aggressively making someone feel less than)

Exclusion (purposefully making someone feel not a part of the group)

Physical Aggression (hitting, kicking, punching, shoving or unwanted physical contact)

Cyber-Disrespect (using social media or the internet to make someone feel uncomfortable)

Threatening (actions and words that purposefully make someone feel afraid)

Stealing or Damaging Property (taking or damaging someone else's possessions)

All of these behaviors apply to this situation

Other:

Required

Is this a recurring event? *

Has it happened before?

Yes

Description *

Please provide a description of the conflict or bullying incident and when it happened.

Who is involved? *

We encourage you to include the names of those involved (select "Other" and type their name), which will allow staff to best aid in finding a resolution to this situation. However, if you choose not to include the names of those involved, select "Prefer not to answer" and an administrator will review the information and do their best to investigate (if appropriate) the situation described.

Prefer not to answer

Other:

Describe the impact that this incident has had.

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