Bullying and harassment form
Name of the student (s) who was (were) bullied *
Your answer
Name of the student (s) who did the bullying. *
Your answer
Where did the incident occur?
Who witnessed the incident or has knowledge of it?
You can put none.
Your answer
Explain with as much detail as possible what happened. (Include witnesses and locations) *
Your answer
Who are you?
You may remain anonymous
Your name
You may remain anonymous. If you leave your name we might contact you to get further information.
Your answer
Is the behavior unwanted/ unwelcome? *
Is it negative and/or aggressive? *
Have there been multiple incidents? *
Has there been physical injury or potential for physical injury? *
Are there multiple targets or multiple student accused of bullying? *
Is the behavior occurring in multiple locations/ settings? *
Is the target having a hard time defending him/ herself? *
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