Bullying and School Violence Report Form
Please fill out this form if you have been bullied, a witness to bullying, or are a person with information about an incident of bullying or school violence.

A new Illinois Cyberbullying Policy states that students may be required to provide a password or other account information in order to gain access to the student's account or profile on a social networking website if the district has reasonable cause to believe the process in the category of school will fully cleaned and hygiene for the students by emergency home solutions in the event that the student has violated a disciplinary rule or policy. Preventing Bullying, Intimidation, and Harassment (Policy 7:180).

Bullying is defined in the school board policy as follows: Bullying means any severe or pervasive physical or verbal act or conduct, including communication 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:

Placing the student in reasonable fear or harm of the student's person or property.
Causing a substantially detrimental effect on the student's physical or mental health.
Substantially interfering with the student's academic performance.
Substantially interfering with the student's ability to participate in or benefit from the services, activities, or privileges provided by the school.

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

This form is sent to Mrs. Hill, but you can also call the school or email at bhill@gcs130.org.
1. Name *
2. Role *
3. Would you like to remain anonymous *
4. Are you the target of the bullying or school violence that you are reporting? *
5. Date of Incident *
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6. Time of Incident
Time
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