YME Bullying Report Form
Reporting bullying or harassing behavior helps make our school a safe and an inviting place to learn. Please report any bullying incidents involving our students using this form. Clicking submit will directly notify school administration and other school staff (ie - school social worker, etc.). We will do our best to ensure that names remain confidential. Please follow up if you do not hear from us in a timely fashion. Thank you for your help in making YME school the best we can be.
Victim Name (First and Last) *
Your answer
May we use your name during our investigation? *
Required
Name of reporter if other than victim *
Your answer
Victim's Grade Level *
Describe the incident, in as much detail as possible. What happened? (provide evidence of bullying ie: are there letters, photos, texts, social media posts, etc.) when available. Please keep track of all physical evidence. *
Your answer
Date and time of incident: *
Example: 01/05/2019 at 2:00 p.m.
Your answer
Location of Incident: *
Example: Hallway, bus, classroom, internet, lunchroom
Your answer
Name(s) of the alleged bully (bullies) and grade levels. *
Your answer
List any other witness(es): *
Your answer
Which of the potential bullying situations best describes the incident? Check all that apply. *
Required
Was the incident reported to anyone else? If so, to whom and when? *
Your answer
Is there anything you may have said or done that the other party or parties may consider is also bullying or have been misunderstood? If yes, please list and explain. *
Your answer
A school official will begin working on this issue. Please feel free to contact us personally (320-564-4081) if you have further questions or concerns. Thank you. BRE Principal Lisa Hansen, YME MS/HS Principal Ryan Luft *
Submit
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