Report Bullying

21 Questions

Elementary
Middle/High School

Chose the appropriate box

Student
Parent
School Staff
Bystander
On school property
On the school bus
Via internet - sent on/off school property
No
Yes, but no medical attention required
Yes, it required medical attention*

Check the statement(s) that best describe what happened

Any bullying, harassment, or intimidation that involved physical aggression
Teasing, name calling, making critical remarks or threatening, in person or by other means.
Demeaning and making the victim of inappropriate jokes
Making threatening gestures
Extorting or exploiting another student
Insults related to a student's disability
Insults related to a student's perceived religious or sexual orientation
Cyberbullying (e.g. texting, email, etc.)
Gang related or recruitment
Human trafficking
Racial harassment
Sexual harassment or inappropriate conduct

Include what the alleged offender(s) said or did.

Yes
No
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