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.
* Required
Has the incident been a:
pattern of behaviors (please list dates below)?
physical act?
threatening communication?
Other (please explain in the incident details)?
If this has been a pattern of behaviors, the bullying or harassing behaviors were:
written.
electronic.
verbal.
Other (please explain in the incident details)
The incident(s) took place:
on school property.
at a school-sponsored function.
on a bus.
Other (please explain in the incident details)
Has the incident:
placed the victim in actual and reasonable fear of harm?
created or is certain to create a hostile environment by interfering with or impairing the victim's educational performance, opportunities, or benefits?
Was the behavior motivated by:
academic status?
ancestry?
color?
gender?
gender identity?
mental, physical, developmental, or sensory disability?
national origin?
physical appearance?
race?
religion?
sexual orientation?
socioeconomic status?
by association with a person who has or is perceived to have one or more of the above characteristics?
Other:
Name of the person making this report (this may be anonymous; however, disciplinary action may not be taken solely on an anonymous report)?
Your answer
What is your contact information (this may be anonymous; however, disciplinary action may not be taken solely on an anonymous report)?
Your answer
In this incident, are you the:
victim?
friend of the victim?
parent?
bystander or witness?
Other:
Clear selection
Location of the behavior being reported:
*
Classroom
Hallway
Cafeteria
School Bus
Gym
Other:
Required
Who is committing the harassment, discrimination, or bullying?
*
Your answer
Who witnessed this behavior?
*
Your answer
When did this occur (dates and times)?
*
Your answer
Who has been the target of the behavior?
*
Your answer
Please give a detailed description of what has happened.
*
Your answer
Are there any other details or information that you would like to share or that would be beneficial to our investigation?
Your answer
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