Bullying, Harassment, or Intimidation Reporting Form | MCPS Form 230-35G
MCPS Form 230-35G | Office of Student and Family Support and Engagement (OSFSE)
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This form is to be confidentially maintained in accordance with the Safe Schools Reporting Act of 2005, Family Educational Rights and Privacy Act, 20 U.S.C. § 1232g.

See Montgomery County Board Policy ACA, Board Policy JHF, Bullying, Harassment, or Intimidation, and MCPS Regulation JHF-RA, for additional information and definitions.
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DIRECTIONS: Complete this form if you are a student victim, the parent/guardian of a student victim, a close adult relative of a student victim, or a school staff member and wish to report an incident of alleged bullying, harassment or intimidation. Return the completed form to the Principal at the alleged student victim’s school. Contact the school for additional information or assistance at any time. Bullying, harassment, or intimidation are serious and will not be tolerated.

In accordance with Maryland law, bullying, harassment, or intimidation means intentional conduct, including verbal, physical, or written conduct or an intentional electronic communication that creates a hostile educational environment by substantially interfering with a student’s educational benefits, opportunities, or performance, or with a student’s physical or psychological well-being, and is:

(1) Either (a) motivated by an actual or perceived personal characteristic including race, ethnicity, color, ancestry, national origin, religion, immigration status, sex, gender, gender identity, gender expression, sexual orientation, family/parental status, marital status, age, physical or mental disability, poverty and socioeconomic status, or language, or other legally or constitutionally protected attributes or affiliations; (b) sexual in nature; or (c) threatening or seriously intimidating; and

(2) Either (a) occurs on school property, at a school-sponsored activity or event, or on a school bus; or (b) substantially disrupts the orderly operation of a school.

Cyberbullying is a form of bullying, harassment, and intimidation. “Cyberbullying” means a communication transmitted by means of an electronic device and includes the use of social media sites. Cyberbullying shall include any future applications that fall under “electronic communication.” “Electronic communication” means a communication transmitted by means of an electronic device, including a telephone, cellular phone, computer, or tablet.
Email *
Person Reporting Incident
Please provide details about yourself so that we can follow up on the alleged incident.
Name *
Please enter your first and last name.
Role *
Please select your role.
Phone Number
Please enter your phone number (optional).
School to Notify
School/Location *
Please select the school/location of one or more of the alleged student victims.
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