Bullying Form Report

We are committed to providing a safe learning environment where your student can thrive. If you feel your student is being bullied, please complete the form below and someone from our school will be in touch with you.

Required

Does what happened fit all three parts of bullying?

It is repeated?
There is an imbalance of power.
The person is being mean on purpose and wants to do harm.

Date

Must contain a date in MM/DD/YYYY format

Email Addressrequired

Time of Dayrequired

Schoolrequired

Grade Levelrequired

Teacherrequired

Name of Targeted Studentrequired

What Happened?required

What has happening before the problem?required

When did it happen?

Where did it happen?required

Other Location

Who was bullying?required

Was an Adult told?required

Yes

Not Sure

If yes, who was told?

What did the adult say the student should do?

Did the student do what the adult said?

Yes

If so, did it help?

Yes

Names of others who saw this happeningrequired