Bullying Form
Bullying Form
Name of Person Making Report (Not required but appreciated)
I AM A
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Student
School Employee
Parent/Guardian
Person being bullied
Concerned Citizen
Friend
Other
Name of person you believe is being bullied:
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Check all that apply:
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Check all that apply:
Physical: Hitting, kicking, or other physical aggression
Verbal: Teasing, name-calling, put-downs, or other behavior that would hurt others' feelings or make them feel bad
Exclusion: Starting rumors, telling others not to be friends with someone, or other action that would cause someone to be without friends
Cyber bullying: Using a computer, cellphone, or other electronic device to engage in any previously mentioned bullying
Please describe what happened. Be as specific as you can. Be sure to include: Who was involved, what happened, where it happened and when it happened.
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I attest that the information I have provided is accurate to the best of my abilities. I have not knowingly falsified the details in this report and understand the information I provide may lead to administrative intervention.
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I attest that the information I have provided is accurate to the best of my abilities. I have not knowingly falsified the details in this report and understand the information I provide may lead to administrative intervention.
I understand and agree
I am willing to be contacted for additional information (please include name, email address or other contact information below: