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Bully Reporting

Bullying is unwanted, aggressive behavior among school-aged children. It involves a real or perceived power imbalance and the behavior is repeated, or has the potential to be repeated, over time.

Your Name*

Answer required for "Your Name"

Who was bullied? (Name and Grade)*

Answer required for "Who was bullied? (Name and Grade)"

Who did the bullying? (Name and Grade)*

Answer required for "Who did the bullying? (Name and Grade)"

When did the bullying happen?*

Answer required for "When did the bullying happen?"

Where did the bullying happen?*

Answer required for "Where did the bullying happen?"

How often has this person bullied the victim within the past month?*

Answer required for "How often has this person bullied the victim within the past month?"

1 Time

2-3 Times

4+ Times

Type of Bullying*

Answer required for "Type of Bullying"

Verbal

Non-verbal

Physical

Cyber-bullying

Other:

Briefly describe the incident*

Answer required for "Briefly describe the incident"

Any other information that you would like to share

Answer required for "Any other information that you would like to share"

If you have previously reported this incident (or prior incidents of bullying involving this bully and victim), to whom was the report submitted, and when?

Answer required for "If you have previously reported this incident (or prior incidents of bullying involving this bully and victim), to whom was the report submitted, and when?"

Confirmation Email

Answer required for "Confirmation Email"