Bullying Report Form
What is Bullying? Bullying is when someone repeatedly and on purpose says or does mean or hurtful things to another person who has a hard time defending himself or herself.

The Elk Expectations are:

1. We will not bully others.

2. We will try to help students who are bullied.

3. We will try to include students who are left out.

4. If we know that somebody is being bullied, we will tell an adult at school and an adult at home.


The Elkhorn Area School District believes in providing a safe and healthy environment for all students. We have created this online form to make it as easy as possible to report incidents of bullying.

Your Name:
Your answer
Relationship to student being bullied: *
If reported to you by someone else, indicate who:
Your answer
Date(s) of incident:
Your answer
Type(s) of Bullying: *
Required
Who was Bullied? (Please list first and last names and grade level of all students, if reporting multiple students.) *
Your answer
Who did the Bullying? (Please list first and last names and grade level of all students, if reporting multiple students.) *
Your answer
Were there any bystanders? If yes, please list first and last name.
Your answer
Where did it happen?
Your answer
Has this happened before?
Briefly describe the incident: *
Your answer
How have you responded?
Your answer
Any other information we need to know?
Your answer
Submit
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