Fulton Elementary School Student Safety Concerns
BULLYING, INTIMIDATION, AND HARASSMENT
Bullying, intimidation, and harassment diminish a student’s ability to learn and a school’s ability to educate. Preventing students from engaging in these disruptive behaviors is important .
Bullying and/or Intimidation is defined as: Repeated intentional behavior by an individual with power over the victim or victims. Such behavior may include, physical, verbal, written or electronic communication or conduct of a belittling or browbeating nature.
Please use this form carefully, think about what has happened and express yourself to the best of your ability.
Your Name (*This is required and will be kept confidential)
Contact Info ( home/cell/email)
Name of adults you have contacted.
Name of Accused *(This will be kept confidential)
Please check the box or boxes that best describe what the accused did.
Physical: Hitting, kicking, shoving, spitting, etc.
Teasing, name calling, put downs, criticizing
Threatening in person, by phone, by e-mail, etc.
Demanding money/homework, etc.
Getting another person to hit or harm a student
Property issues ( hiding of property, damaging, taking)
Making rude and /or threatening gestures
Spreading harmful rumors, gossip or photos
Description of current incident. Include date and time
Where did the incident happen?
To and from school
If you marked "other" on the previous question, please explain.
Please list any witness.
Any previous incidents, please explain
How did you respond to the incident?
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This form was created inside of River Bend CUSD #2.