Bullying Report Form
Click "Submit" when complete. An email will be sent to JCMS Administration whenever this form is completed. Thank you for making JCMS a safer place!
Name of person being bullied:
Date bullying occurred (mm/dd/yy):
Name of bully:
You name (optional):
Person being bullied
Type of bullying:
Physical - hitting, kicking, other physical aggression
Verbal - teasing, name calling, put-downs, other behavior that would make someone feel badly
Emotional - starting rummors, excluding someone intentionally, actions to cause others to not have friends
Cyber - using technology to engage in bullying behaviors
Description of events - please be very specific including, times, location and actions:
Did you witness the bullying:
List any other witnesses that saw the bullying occur:
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