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Bullying Report Form

Bullying is unwanted, aggressive behavior among school aged children that involves a real or perceived power imbalance. The behavior is repeated, or has the potential to be repeated, over time. It can be in the form of an electronic, written, verbal, or physical act toward a student that meets one or more of the following conditions:

• Places the student in reasonable fear of harm to the student’s person or property; 

• Has a substantially detrimental effect on the student’s physical or mental health; 

• Has the effect of substantially interfering with the student’s academic performance; or 

• Has the effect of substantially interfering with the student’s ability to participate in or benefit from the services, activities, or privileges provided by a school.

Please use this form to report information about bullying you have witnessed, or experienced:







*  Indicate fields that must be completed.



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