Eula Elementary School Bully Report Form
Bullying is defined in the Eula ISD Policy as:
Bullying means a single significant act or a pattern of acts by one or more students directed at another student that exploits an imbalance of power. It involves engaging in written or verbal expression, expression through electronic means, or physical conduct It occurs on school property, at a school-sponsored or school-related activity, or in a vehicle operated by the district
- It has the effect or will have the effect of physically harming a student, damaging a student ’s property, or placing a
student in reasonable fear of harm to the student’s person or of damage to the student ’s property;
- Or is sufficiently severe, persistent, or pervasive enough that the action or threat creates an intimidating, threatening, or
abusive educational environment for a student;
- Or materially and substantially disrupts the educational process or the orderly operation of a classroom or school;
- Or infringes on the rights of the victim at school; and includes cyber-bullying.
“Cyberbullying" means bullying that is done through the use of any electronic communication device, including through the use of a cellular or other type of telephone, a computer, a camera, electronic mail, instant messaging, text messaging, a social media application, an Internet website, or any other Internet-based communication tool.
This applies to: bullying that occurs on or is delivered to school property or to the site of a school-sponsored or school-related activity on or off school property; bullying that occurs on a publicly or privately owned school bus or vehicle being used for transportation of students to or from school or a school-sponsored or school-related activity; and cyber-bullying that occurs off school property or outside of a school-sponsored or school-related activity if the cyber-bullying:
- interferes with a student ’s educational opportunities;
- or substantially disrupts the orderly operation of a classroom, school, or school-sponsored or school-related activity.
You have the right to remain anonymous when filling out this report. It is important to provide the name of the alleged victim, alleged bully, date, time, and location of the incident and what actions were done to help with the investigation of this incident and the supervision of students.
Person Reporting (optional)
I am a:
Parent or Guardian
I wish to remain anonymous
Alleged Victim's Name:
Alleged Bully's Name:
Alleged Bully's Grade:
In what way does the alleged bully have more power than the alleged victim?
The alleged bully is physically bigger, physically stronger, or is older than the alleged victim
The alleged bully uses other individuals to create an imbalance of power
The alleged bully is more popular than the alleged victim
Is the alleged bullying you are reporting:
person to person
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