MHS Bullying Report Form
Please report any bullying incidents you feel may be going on at school. All reports will be investigated by the administration.
Location of Bullying
Where did you experience or witness bullying take place?
In your classroom
In the hallway
Outside, but on school property
In the locker room
Outside of the school day
On the internet (cyber bullying)
Type of Bullying
What did you experience or witness?
Verbal bullying (using words)
Physical bullying (pushing/hitting)
Emotional bullying (exclusion/dirty looks)
Cyber bullying (on the internet)
Posturing (physical intimidation)
If the above response was cyber bullying, please indicate all the sources. i.g. text message, e-mail, social media platform, etc. If social media was used, please identify the platform(s) used. i.g. Instagram, Facebook, Twitter, Snapchat, etc.
Your Role in the Bullying
Please name target(s).
Who was being bullied?
Please name the bully/bullies in this incident.
Please list any bystanders that witnessed the incident.
Please describe what happened using as much detail as you can.
Is this your first report of this incident to an adult?
If you reported the incident to an adult, please name that person.
Send me a copy of my responses.
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This form was created inside of Meade Public Schools USD 226.