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Anti-Bullying Form
Anti-Bullying Form

ANONYMOUS BULLYING INCIDENT FORM

If you would like to anonymously‚Äč report a bullying incident, please fill out the form below.

Definition of Bullying

A. “Bullying” means the repeated use by one or more students of a written, verbal or electronic communication, such as cyberbullying, or a physical act or gesture directed at another student attending school in the same district that: 1. causes physical or emotional harm to such student or damage to such student’s property; 2. places such student in reasonable fear of harm to himself or herself, or of damage to his or her property; 3. creates a hostile environment at school for such student; 4. infringes on the rights of such student at school; or 5. substantially disrupts the education process or the orderly operation of a school.

B. Bullying shall include, but not be limited to, a written, verbal or electronic communication or physical act or gesture based on any actual or perceived differentiating characteristics, such as race, color, religion, ancestry, national origin, gender, sexual orientation, gender identity and expression, socioeconomic status, academic status, physical appearance, or mental, physical, developmental or sensory disability, or by association with an individual or group who has or is perceived to have one or more of such characteristics. 

 

DATE AND TIME

Please check the type(s) of bullying you are reporting.

Physical Bullying

Verbal Bullying

Social Bullying

Cyber Bullying

Name of student being bullied

Name of student(s) who are bullying

*

Please describe bullying incident(s) and area(s) in which bullying is occurring.

 



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