Online Bullying Reporting

Online Bullying Reporting

Online Bullying Reporting

Definition of bullying: By any means including, but not limited to, in person, telephone, cyberbullying, hazing, writing, or via electronic communications for the purpose of intimidation, unwanted aggressive behavior, or harassment that substantially interferes with the educational performance opportunities, or benefits of any student without exception, or that substantially disrupts the orderly operation of the school and that is repetitive and/or substantially likely to be repeated.

* Required

Date of Incident:*
Name of Person Bullying:*
Name of Person Being Bullied:*
Your Name (optional):
Your Contact Information (optional):

I am a:*



 Staff Member

 Friend of Bully

Type of Bullying:*

(check all that apply)

Phsyical: Hitting, kicking, other aggression

Verbal: Teasing, name calling, put downs, or other behaviors that would hurt other feelings or make them feel bad

Emotional/Exclusion: Starting rumors, telling others not to be friends with someone or other actions that would cause someone to be without friends

Cyber Bullying: Using an electronic medium to engage in any previously mentioned act of bullying

Did you witness the bullying?*



If you did not witness the event, how did you hear about the bullying?*

Description of the event:*

(Please be specific: Location, Date, Time)


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