Bullying

Bullying Report Form

 

GENOA-KINGSTON CUSD 424

Bullying Report Form

Instruction:  Please complete form as detailed as possible.  You may respond only to the questions that you feel comfortable answering and are able to accurately answer.  You may choose to include your name at the bottom of the form or submit it anonymously. Please note that an anonymous complaint or lack of information limits the administration’s ability to investigate the bullying report.

Definition of Bullying:  In order to consider bullying, the behavior must be:

  1.  An imbalance of Power: such as physical strength and/or access to embarrassing information.
  2. REPETITION:  Bullying behaviors happen MORE THAN ONCE

Complete the form and click submit or or click on the following link for a Word document to completed and turn in to the BULLYING REPORT BOX or a Middle School Staff Member.    

Bully Report Form

Cyberbullying Powerpoint

 

 

Bullying

Date of report:

Alleged Student Bully(ies):

 Grade:

 Grade:

 Grade:

Alleged Student Target(s)  (Name of victim or listing of witnesses required)

 Grade:

 Grade:

 Grade:

Type of Bullying:

Verbal 
Cyber
Physical
Other

 

Bullying Behavior: (Check all that apply)

Shoved/Pushed 

Hit/Kicked/PunchedThreatened

Stole/Damaged Possessions;

Excluded

Taunting/ridiculing

Cyber

Inappropriate Touching

Racial

 

Described what happened in detail:

 

How long has this been happening? (Be specific) 

 

Where did this happen? (Examples: Bus stop, bus, cafeteria, hallway, classroom, locker room, etc.)



Security Measure
Website by SchoolMessenger Presence. © 2017 West Corporation. All rights reserved.