Bullying is defined as the repeated use by one or more students of a written, verbal, or electronic expression, or physical act or gesture or any combination directed at a target that causes the following:
Physical or emotional harm to the target, damage to the target's property, places the target in reasonable fear of harm to him or herself, creates a hostile environment at school for the target, infringes on the rights of the target at school, substantially disrupts the education process or orderly operation of a school.  
Directions: By law, all school employees are required to report alleged acts of bullying.  Please complete this form.  If you are a student, parent, or volunteer and wish to remain anonymous please omit signature and name.  All reports of bullying will be investigated and parties will be informed. 
(Note: Reports may be made anonymously, but no displinary action will be taken against an alleged aggressor solely on the basis of an anonymous report.)
School *
Grade *
Grade of the Alleged Offender *
Where did the incident happen? *

Please check each statement that best describes what was observered *
What actions, if any, were taken at time of incident? *
What Actions, if any, were taken at time of incident? *