Tip 62 - Bully Prevention

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This form offers any member of the Gower Community an opportunity to report bullying or any other incident of concern to school administrators openly or in an anonymous fashion. If this is an urgent matter, please contact the school office directly. Gower West and Gower Middle can be reached at 630-986-5383. If you feel this is an emergency, please contact your local law enforcement agency.

If you feel this is an emergency, please contact your local law enforcement agency.

Gower School District 62 has taken a strong stand against bullying which is defined in our district as follows:

Any severe or repeated physical or verbal act or conduct, including communications made in writing or electronically, directed toward a student that has or can be reasonably predicted to have the effect of one or more of the following:

1. Placing the student in reasonable fear of harm to the student’s person or property.

2. Causing a substantially detrimental effect on the student’s physical or mental health.

3. Substantially interfering with the student’s academic performance.

4. Substantially interfering with the student’s ability to participate in or benefit from the services,

activities, or privileges provided by a school.

Bullying, intimidation, and/or harassment may take various forms, including without limitation: threats, stalking, physical violence, sexual harassment, sexual violence, theft, public humiliation, destruction of property, or retaliation for asserting or alleging an act of bullying.

This is a report about: *

Gower West (Pre-K - 4th grade)

Gower Middle (5th - 8th grade)

I am a: *

Victim (it happened to me)

Witness (I saw it happen)

Staff Member

Parent/Guardian

Community Member

Other:

When did the incident occur? *

(What day did this happen?)

YYYY

At what time did the incident occur? *

(What time did it happen?)

Time

Where did the incident occur? *

(Where did it happen?)

Hallway

Classroom

Lunch room

Locker room

Bus

Bus stop or on the way to/from school

Gym

Playground

Off of school property

Other:

If the incident occurred off of school property, where did it happen?

Is this a bullying incident? *

Yes

If this is a bullying incident, who is being the bully?

If this is a bullying incident, please check all that apply

Emotional/Exclusion - Starting rumors, telling others not to be friends with someone, or other actions that would cause someone to be without friends

Physical - Hitting/kicking/other physical aggression

Verbal - Teasing, name-calling, put downs, or other behavior that would hurt others' feelings or make them feel bad

Cyber - Using texts, social networks, chat rooms, blogs, e-mails, or other electronic medium to emotionally or verbally bully

Please describe what happened. Write down exactly what was said and done. *

Your name and grade

(Optional)

Please add the names and grades of others who saw what happened. Add the name(s) of any adult(s) that may have seen what happened.

What do you think caused this to happen?

Submit

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