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)
Verbal (Teasing, Taunting, Insulting)
Non-verbal (Exclusion, Inappropriate Gestures)
Physical (Pushing, Shoving)
Who was Bullied? (Please list first and last names and grade level of all students, if reporting multiple students.)
Who did the Bullying? (Please list first and last names and grade level of all students, if reporting multiple students.)
Were there any bystanders? If yes, please list first and last name.
Has this happened before?
NO, this is the first time.
YES, this has happened once before
This is an ongoing problem.
Briefly describe the incident:
How have you responded?
Your Name (optional)
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This form was created inside of Palmyra-Eagle Area School District.