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. 
School *
Grade *
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Grade of the Allged 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? *
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