Almond-Bancroft Bullying, Harassment, and Intimidation Report Form
Bullying Definition: Bullying is intentional and unwanted behavior that involves an imbalance of power*. The behavior is repeated, or has the potential to be repeated, over time. Bullying behaviors are aggressive and create an intimidating, hostile, or offensive learning environment.

*Imbalance of power: Using physical strength, access to embarrassing information, popularity (using bullying as a means to keep popularity/power OR using bullying as a means to climb the social ladder and/or lower someone else’s popularity), etc. to control or harm others.

Harassment Definition: Harassment is unwelcome conduct based on a protected class (race, national origin, color, sex-based (including sexual orientation), age, disability, religion) that is severe, pervasive, or persistent and creates a hostile environment. Harassment also includes sexual harassment, which refers to behaviors that are not welcome, that are personally offensive, that debilitate morale, and that interfere with the academic performance of its victims or their peers. Sexual harassment may also include, but is not limited to, actions such as sexually-oriented verbal “kidding” or abuse, pressure for sexual activity, sexual contact and unwelcomed touching, display of sexually suggestive objects or pictures, demands for sexual favors accompanied by implied or overt promises of preferential treatment or threats concerning an individual’s employment or academic status, any job or academic-related action that is based upon an individual’s acceptance of, resistance to, or refusal of sexual overtures.

Intimidation Definition: Intimidation is behaving in such a way as to make another feel timid or fearful. This includes overt or implied threats and/or physical gestures.

*See Bullying, Harassment, and Intimidation Policy for additional definitions and procedures: http://goo.gl/r6bWnW

Thank you for reporting this information. We will be following up on this shortly. You may be called into the office if we feel that we need additional information or clarification. We will not be disclosing your name as a reporter.

Name (optional)
Including your name is preferred so that we are better able to adequately investigate the incident(s) being reported. Your name, and the information you share, will be kept confidential and will not be shared with others. It is also important to include your name so that we are able to follow up with you regarding the outcome of our investigation.
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I am reporting: *
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Witnessed by me: *
Reported by: *
Date of Incident(s) *
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Time of Incident(s) *
Your answer
Location of Incident(s) *
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Name(s) of student(s) doing the bullying *
Your answer
Name(s) of student(s) being bullied *
Your answer
Witnessed by others? Who? *
Your answer
Description of events (please be specific) *
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Do you have any proof or evidence of what happened? *
Please provide evidence, such as notes, letters, pictures, etc. to Mrs. McDonald (K-7) or Ms. Spear (8-12)
How long has this been happening? *
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What steps have you taken to try to make the bullying stop? *
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All of the information provided on this form is accurate to the best of my knowledge. *
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