Student Bullying Reporting Form

Bullying, harassment, or intimidation are serious and we will not tolerate this behavior. Bullying occurs when a student or group of students engages in written or verbal expression, expression through electronic methods, or physical conduct against another student on school property, at a school sponsored or related activity, or in a district operated vehicle, and the behavior:

  • Results in harm to the student or the student’s property,
  • Places a student in reasonable fear of physical harm or of damage to the student’s property, or
  • Is so severe, persistent, and pervasive that it creates an intimidating, threatening, or abusive educational environment.

This conduct is considered bullying if it exploits an imbalance of power between the student perpetrator(s) and the student victim and if it interferes with a student’s education or substantially disrupts the operation of the school.

If you are a student victim, the parent/guardian of a student victim, a close adult relative of a student victim, or a school staff member and wish to report an incident of alleged bullying harassment or intimidation, complete this form.

Person reporting the incident:
Relationship to the victim:
Is he/she a student?
What campus does the student attend?
Which campus did the incident happen?
Specify the location:
Please list all names of who is committing the bullying:
Is he/she a student?
Is he/she a student?
Did anyone else witness the bullying? List names below:
Did physical injury result from this incident?
Was there damage to anyone's personal property?
Was the student absent from school as a result of the incident?
Describe the incident below:
Please describe what happened (choose all that apply):