Tonawanda CSD Bully Reporting Form
New York State’s Dignity for All Students Act (The Dignity Act) seeks to provide the State’s public elementary and secondary school students with a safe and supportive environment free from discrimination, intimidation, taunting, harassment, and bullying on school property, a school bus and/or at a school function.
Additionally, under the Dignity Act, schools will be responsible for collecting and reporting data regarding material incidents of discrimination and harassment.
“Harassment” means: (1) the creation of a hostile environment by conduct or by verbal threats, intimidation or abuse that has or would have the effect of unreasonably and substantially interfering with a student's educational performance, opportunities or benefits, or mental, emotional or physical wellbeing; or (2) conduct, verbal threats, intimidation or abuse that reasonably causes or would reasonably be expected to cause a student to fear for his or her physical safety; and such conduct, verbal threats, intimidation or abuse includes but is not limited to conduct, verbal threats, intimidation or abuse based on a person's actual or perceived race, color, weight, national origin, ethnic group, religion, religious practice, disability, sexual orientation, gender or sex (Education Law Section 11).
Any person who has reasonable cause to suspect that a student has been subjected to bullying, discrimination and/or harassment by an employee or student, on school grounds or at a school function can fill out this form.
Complainant Home/Cell Phone
Please include area code and do not include parentheses or dashes.
Target (Victim/s) Name
Please list the offender(s) name, sex and grade/position if applicable.
Please list the witness(es) name, grade/position if applicable and phone.
Where did the incident take place?
On school property
At school-sponsored function off school grounds
Date and Approximate Time of Incident
Incident Description of Discriminatory and/or Harassing Behaviors
Type of bias is based on the person's actual or perceived (please check all that apply).
Description of the Incident
Check all that apply.
Incident involved intimidating or abuse but no verbal threat or physical contact
Incident involved verbal threats but no physical contact
Incident involved physical contact but no verbal threat
Incident involved both verbal threat and physical contact
Incident involved only student offenders
Incident involved threats via social media
Was the incident...
directly observed by you
the result of an investigation of a written or oral complaint brought to you by the victim and/or a witness
Tonawanda Dignity Act Coordinators
Mary Beth Scullion, assistant superintendent for curriculum & instruction - 694-7688
Michael Brown, high school principal - 694-7670
Lyndsey Todaro, high school assistant principal - 694-7670
David Sellan, middle school principal - 694-7660
Robert Ross, Mullen principal - 694-6805
Claudia Panaro, Riverview principal - 694-7697
Marie Burger, Mullen/Riverview social worker - 694-6805
**NOTE: False reporting of an incident is against state law and school policy 7311. Section 240.50 of the New York State Penal Law states: A person is guilty of falsely reporting an incident when, knowing the information reported, conveyed or circulated to be false or baseless, he/she initiates a false report or warning of an alleged occurrence or impending occurrence of a crime, catastrophe or emergency under circumstances in which it is not unlikely that public alarm or inconvenience will result. This is a Class A Misdemeanor.
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This form was created inside of Tonawanda City School District.