River Bend Middle School Student Safety Concerns
Bullying, intimidation, and harassment diminish a student’s ability to learn and a school’s ability to educate.  Preventing students from engaging in these disruptive behaviors is important .

Bullying and/or Intimidation is defined as: Repeated intentional behavior by an individual with power over the victim or victims. Such behavior may include, physical, verbal, written or electronic communication or conduct of a belittling or browbeating nature.

Please use this form carefully, think about what has happened and express yourself to the best of your ability.
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Your Name (*This is required and will be kept confidential) *
Date *
Contact Info ( home/cell/email) *
Name of adults you have contacted.
Name of Accused *(This will be kept confidential) *
Please check the box or boxes that best describe what the accused did. *
Description of current incident.  Include date and time *
Where did the incident happen? *
If you marked "other" on the previous question, please explain.
Please list any witness.
Any previous incidents, please explain
How did you respond to the incident?
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