Quick Links

Skip to main content Skip to navigation

Main Navigation

Top

Bullying Report Form

Home > breadcrumbs: Students > breadcrumbs: Bullying Report Form >

Working...

Ajax Loading Image

 

Bullying Form

When looking at the totality of the circumstances, harassment and bullying mean any electronic, written, verbal, or physical act or conduct toward a student which is based on any actual or perceived trait or characteristic of the student and which creates an objectively hostile school environment that meets one or more of the following conditions:

• Places the student in reasonable fear of harm to the student’s person or property; 

• Has a substantially detrimental effect on the student’s physical or mental health; 

• Has the effect of substantially interfering with the student’s academic performance; or 

• Has the effect of substantially interfering with the student’s ability to participate in or benefit from the services, activities, or privileges provided by a school.

Please use this form for reporting information about bullying you have witnessed, or experienced:

         

 

Name*: (person reporting incident) 

E-mail:  

Date of bullying incident:  

Time of day of incident:

Location of incident*:

Other possible witnesses:  

Who was being bullied*?    

(If you don't know the victim's name, please provide whatever information you can to assist us such as an age estimate, physical description, etc.)

Building:  

Who was doing the bullying*?   

(If you don't know the aggressor's name, please provide whatever information you can to assist us such as an age estimate, physical description, etc.)

Building:  

Details/Description of incident*:  

(*Indicates a field that must be filled out to submit this form)

 

Back To Top