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Students
Bullying Report Form
This form requires Javascript to be enabled for submission and authorization.
*
Required
This form is monitored during school hours. If you need immediate support, call 988.
Date
Must contain a date in M/D/YYYY format
Date of Incident (If you don't know the exact time, feel free to use a descriptor such as before school, during a specific class period, during lunch, after school, night time, passing periods, etc.)
*
required
Which choice best describes what happened?
*
required
Physical (pushing, shoving, spitting, hitting, kicking, destruction of property, theft, etc.)
Verbal/Non-verbal (name calling, teasing (making fun), spreading false rumors, intimidation, public humiliation, putting down, threats, etc.)
Social/Emotional (rumors, racial slurs, gossip, social exclusion, peer pressure, sexual/religious/racial harassment, etc.)
Cyber Bullying (inappropriate blog or social media posts, stalking, posting inappropriate pictures and comments, etc.)
Other
Describe, in detail what happened including the witness(es) roles.*The word “target” means the person who was bullied. The word “aggressor” means the person who was doing the bullying. The word “bystander” means people who might have seen or heard the incident as it was happening. This might be someone who saw fight, read something on Facebook, or saw a text between two people. There is often more than one target and one aggressor involved in bullying incidents. Please give us as much information as you can about all the people involved.
*
required
Is this a repeated/persistent action of the bully?
*
required
Victim/Target's Name (first and last)
*
required
Victim/Target Gender:
Male
Female
Unspecified
Victim/Target School Attending
*
required
Accused Name (first and last)
*
required
Accused School Attending
Accused Grade
Accused Age
Accused Gender:
Male
Female
Unspecified
Witness #1 Name (first and last)
Witness #1's School Attending
Witness #1's Grade
Witness #1's Gender
Male
Female
Unspecified
Witness #2 Name (first and last)
Witness #2's School Attending
Witness #2's Grade
Witness #2's Gender
Male
Female
Unspecified
Is there an adult/teacher who could provide more information? Please provide the name:
Reporter's Email Address (optional):
Reporter's Name (optional):After the report is filed, the administration designated in the building will conduct an investigation and contact you with the outcome. The report will be filed in each building.
Submit
