Elgin High School - Anonymous Bullying Reporting Form
2017-2018
Definition of Bullying
Bullying is defined in Section 37.0832 of the Education Code as a single significant act or a pattern of acts by one or more students directed at another student that exploits an imbalance of power and involves engaging in written or verbal expression, expression through electronic means, or physical conduct that:
• Has the effect or will have the effect of physically harming a student, damaging a student’s property, or placing a student in reasonable fear of harm to the student’s person or of damage to the student’s property;
• Is sufficiently severe, persistent, or pervasive enough that the action or threat creates an intimidating, threatening, or abusive educational environment for a student;
• Materially and substantially disrupts the educational process or the orderly operation of a classroom or school; or
• Infringes on the rights of the victim at school.

Bullying includes cyberbullying. This state law on bullying prevention applies to:
• Bullying that occurs on or is delivered to school property or to the site of a school-sponsored or school-related activity on or off school property;
• Bullying that occurs on a publicly or privately owned school bus or vehicle being used for transportation of students to or from school or a school-sponsored or school-related activity; and
• Cyberbullying that occurs off school property or outside of a school-sponsored or school-related activity if the cyberbullying interferes with a student’s educational opportunities or substantially disrupts the orderly operation of a classroom, school, or school-sponsored or school-related activity.

If you have information regarding a bullying incident and would like to report this information anonymously, please fill out the following form to the best of your knowledge. Please note that this form is completely anonymous.
Incident Date
MM
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DD
/
YYYY
Incident Time
Time
:
Alleged Victim's Name
Your answer
Alleged Victim's School
Elgin High School
Alleged Victim's Grade Level
Alleged Victim's Age
Your answer
Alleged Bully's Name
Your answer
Alleged Bully's School
Alleged Bully's Grade Level
Alleged Bully's Age
Your answer
Where did the incident occur? (Please be as specific as possible.)
Your answer
List the names of any witnesses to the incident.
Your answer
Describe what occurred. (Please provide specific details.)
Your answer
This report is anonymous. However, if you would like to speak with a campus administrator, please provide your name, phone number and e-mail address so someone can contact you about this incident.
Your Name:
Your answer
Your Phone Number:
Your answer
Your E-mail Address:
Your answer
Thank you, this report will be followed-up within two school/work days.
*If you think this incident requires immediate attention, please contact the school Principal or Assistant Principal.
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