Bullying/Harassment Incident Reporting Form

Providence Hall Charter School is committed to providing all students and staff with a safe and civil environment in which all members of the school community are treated with dignity and respect. Bullying/harassment is any electronic, written, verbal, or physical act or conduct toward a person based on any actual or perceived trait or characteristic of the person and which creates a hostile school environment that meets one or more of the following conditions:
- Places the student in reasonable fear of harm to the student's person or property.
- Has a substantially detrimental effect on the student's physical or mental health.
- Has the effect of substantially interfering with a student's academic performance.
- Has the effect of substantially interfering with the student's ability to participate in or benefit from the services, activities, or privileges provided by a school.

Note* This form will be checked during school hours, not on weekends or holidays.


This form's data is confidential and will not be shared with anyone that does not have a need to know.

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