Report of Harassing or Bullying Behavior
N.C. General Statute 115C-407.15 - Bullying and Harassing Behavior Definition:  Bullying or harassing behavior is any pattern of gestures or written, electronic, or verbal communications, or any physical act or threatening communication that takes place on school property, at any school-sponsored function, or on a bus, and that  (1) Places a student or employee in actual and reasonable fear of harm or (2) creates or is certain to create a hostile environment by interfering with or impairing a student's educational performance, opportunities, or benefits.

Bullying or harassing behavior includes, but is not limited to, acts reasonably perceived as being motivated by any actual or perceived differentiating characteristic, such as race, color, religion, ancestry, national origin, gender, socioeconomic status, academic status, gender identity, physical appearance, sexual orientation, or mental, physical, developmental, or sensory disability, or by association with a person who has or is perceived to have one or more of these characteristics.
Sign in to Google to save your progress. Learn more
Name of the person making this report (this may be anonymous; however, disciplinary action may not be taken solely on an anonymous report)?
What is your contact information (this may be anonymous; however, disciplinary action may not be taken solely on an anonymous report)?        
Has the incident been a:
If this has been a pattern of behaviors, the bullying or harassing behaviors were: (Check all that apply)
The incident(s) took place: (Check all that apply)
Has the incident:
Was the behavior motivated by: (Check all that apply)
In this incident, are you the:
Clear selection
Location of the behavior being reported: (Check all that apply) *
Who is committing the harassment, discrimination, or bullying? *
Who witnessed this behavior? *
When did this occur (dates and times)? *
Who has been the target of the behavior? *
Please give a detailed description of what has happened. *
Are there any other details or information that you would like to share or that would be beneficial to our investigation?
Clear form
Never submit passwords through Google Forms.
This form was created inside of Stokes County Schools. Report Abuse