Bullying, Harassment, or Intimidation Reporting Form | MCPS Form 230-35G
MCPS Form 230-35G | Student  Welfare and Compliance
-------------------------------------------------------------
This form is to be confidentially maintained in accordance with the Safe Schools Reporting Act of 2005, Family Educational Rights and Privacy Act, 20 U.S.C. § 1232g.

See Montgomery County Board Policy ACA, Board Policy JHF, Bullying, Harassment, or Intimidation, and MCPS Regulation JHF-RA, for additional information and definitions.
-------------------------------------------------------------
DIRECTIONS: The Bullying, Harassment or Intimidation Reporting Form should be used to report alleged incidents of bullying, harassment, or intimidation that occurred during the current school year on school property, at a school-sponsored activity or event off school property, on a school bus, on the way to and/or from school, or through personal mobile device on or off school property. School staff will address incidents that occur at school or have a connection or nexus back to the school setting that create a risk of harm to other students while they are at school or interfere with the educational environment. If you are a student, the parent/guardian or a family member of a student, a school staff member, or a bystander and wish to report an incident of alleged bullying, cyberbullying, harassment, or intimidation, please complete this form and return it to the school principal. You may contact the school for additional information or assistance at any time. (Bullying, cyberbullying, harassment, and intimidation definitions are provided below.)

BULLYING —is unwanted, demeaning behavior among students that involves a real or perceived power imbalance. The behavior is repeated, or is highly likely to be repeated, over time. In order to be considered bullying, the behavior must be intentional and include 1) An imbalance of power (students who bully use their physical, emotional, social, or academic power to control, exclude, or harm others) and 2) Repetition (bullying behaviors happen more than once or are highly likely to be repeated based on evidence gathered).

CYBERBULLYING —is bullying transmitted by means of personal mobile devices through electronic communication that allows individuals to view or share content. Cyberbullying includes sending, posting, or sharing personal or private information about someone causing embarrassment or humiliation.

HARASSMENT —includes actual or perceived negative actions that offend, ridicule, or demean another student with regard to race, ethnicity, national origin, immigration status, family/parental or marital status, sex, sexual orientation, gender identity, gender expression, religion, ancestry, physical attributes, socioeconomic status, physical or mental ability, or disability.

INTIMIDATION —is any communication or action directed against another student that threatens or induces a sense of fear and/or inferiority. Retaliation may be considered a form of intimidation.
Sign in to Google to save your progress. Learn more
Email *
Person Reporting Incident
Please provide details about yourself so that we can follow up on the alleged incident.
Name *
Please enter your first and last name.
Role *
Please select your role.
Phone Number
Please enter your phone number (optional).
School to Notify
School/Location *
Please select the school/location of one or more of the alleged student victims.
Next
Clear form
Never submit passwords through Google Forms.
This form was created inside of Montgomery County Public Schools. Report Abuse