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GKMS: Bullying

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GKMS Bullying Report

Bullying Report Form

Date of report:

Report filed by (optional):

Alleged Student Bully(ies):

Grade:

Grade:

Grade:

Alleged Student Target(s)

Grade:

Grade:

Grade:

List the events that have occurred:

How long has this been happening? Be specific.

When and where is it happening? (Examples: at the bus stop, at home, in class, in the hallway, during lunch, in the locker room, between classes, in the bathroom)

What did you do when it happened? Please list all of the ways that you responded.

Witnesses (adults and/or students) who might have observed the incident.

Who have you reported this to (Check all that apply)

Nobody

Parent(s)

Friend(s)

Counselor

Administrator

Bus Driver

Teacher    Teacher's Name:

Other - Name:

What would you like for an adult to do to help you? (Example: listen to me, talk to the other student(s), watch out for similar behavior, tell an administrator)

If you do not want an intervention for this incident, please check here

Your Name: (Optional)

Date:

 

Complete above 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.    Bullying Report Form

Cyberbullying PowerPoint

 

 
 

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