PEASD Bullying Report Form
What is Bullying?

Bullying is when someone repeatedly and on purpose says or does mean or hurtful things to another person who has a hard time defending himself or herself.

The Panther Principles are:

1. We will not bully others.

2. We will try to help students who are bullied.

3. We will try to include students who are left out.

4. If we know that somebody is being bullied, we will tell an adult at school and an adult at home.

The Palmyra-Eagle Area School District believes in providing a safe and healthy environment for all students. We have created this online form to make it as easy as possible to report incidents of bullying.

Your relationship to student being bullied: *
Behavior (check all that apply) *
Required
Who was Bullied? (Please list first and last names and grade level of all students, if reporting multiple students.) *
Your answer
Who did the Bullying? (Please list first and last names and grade level of all students, if reporting multiple students.) *
Your answer
Were there any bystanders? If yes, please list first and last name.
Your answer
Location: *
Your answer
Date: *
MM
/
DD
/
YYYY
Time: *
Time
:
Has this happened before? *
Briefly describe the incident: *
Your answer
How have you responded? *
Your answer
Your Name (optional)
Your answer
Submit
Never submit passwords through Google Forms.
This form was created inside of Palmyra-Eagle Area School District. Report Abuse - Terms of Service - Additional Terms