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Incident Reporting Form

To report a bullying incident, please complete this form. Don'€™t forget to click the Submit button at the bottom of the form.

Definition: A person is bullied when he or she is exposed, repeatedly and over time, to negative actions on the part of one or more other persons, and he or she has difficulty defending himself or herself."

"Bullying" is the repeated use by one or more students of a written, verbal, or electronic expression or a physical act or gesture or any combination thereof, directed at a target (victim) that:  (1) causes physical or emotional harm to the victim or damage to the victim's property; (2) places the victim in reasonable fear of harm to himself or of damage to his property; (3) creates a hostile environment at school for the victim; (4) infringes on the rights of the victim at school; (5) materially or substantially disrupts the education process or the orderly operation of a school.  

Please note that while all reports of bullying will be investigated, no disciplinary action will be taken against a student solely on the basis of an anonymous report.

Where did the incident happen? Choose all that apply.

Yes    No


etc.? Yes    No

Please select the statement(s) that best describe what happened. Choose all that apply.

Yes    No

Yes    No

Yes    No

Yes    No