Tip 62 - Bully Prevention
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.
Sign in to Google to save your progress. Learn more
This is a report about: *
I am a: *
When did the incident occur? *
(What day did this happen?)
At what time did the incident occur? *
(What time did it happen?)
Where did the incident occur? *
(Where did it happen?)
If the incident occurred off of school property, where did it happen?
Is this a bullying incident? *
If this is a bullying incident, who is being the bully?
If this is a bullying incident, please check all that apply
Please describe what happened. Write down exactly what was said and done. *
Your name and grade
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?
Clear form
Never submit passwords through Google Forms.
This form was created inside of Gower School District 62. Report Abuse