Brazos ISD Bully Reporting Form
Name of Person being bullied
Date bullying occurred
Campus alleged bullying victim attends
Brazos Middle School
Brazos High School
Prairie Harbor Alternative School
Your Name (Optional)
I am a:
Person being buillied
Type of Bullying (select all that apply)
Physical: Hitting/kicking/other physical aggression
Verbal: Teasing, name-calling, put-downs, or other behavior that would hurt others' s feelings or make them feel bad
Emotional/Exclusions: Starting rumors, telling others not be friends with someone, or other actions that would cause someone to be without friends.
Cyber Bullying: Using electronic medium to engage in any previously mentioned bullying
Where did the bullying occur?
At bus stop
On school bus
Was this alleged incident based on the alleged victim's
Perceived Sexual Orientation
Did you witness the bullying?
Was the alleged victim absent from school as a result of the incident?
List other students/staff who may have witnessed the bullying:
Describe the events.
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