West Elk Schools Bullying Report Form

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What is bullying?

Bullying is aggressive behavior that is intentional and that involves an imbalance of power or strength. Typically, it is repeated over time. A child who is being bullied has a hard time defending himself or herself. Bullying can take many forms, such as:

Hitting or punching (physical bullying).
Teasing or name-calling (verbal bullying).
Intimidation using gestures or social exclusion (nonverbal bullying or emotional bullying).
Sending insulting messages by email (cyberbullying).

Email *

Your Name *

Relationship to Victim *

Date of Incident *

YYYY

Type of Bullying (see descriptions above): *

Verbal

Non-verbal/Emotional

Physical

Cyberbullying

Required

Who was Bullied? (Please list first and last names of all students, if reporting multiple students.) *

Who did the Bullying? (Please list first and last names of all students, if reporting multiple students.) *

Were there any bystanders? If yes, please list first and last name.

Where did it happen? *

Time of day? *

Morning

Lunch/Recess

Afternoon

Other:

Has this happened before? *

NO, this is the first time.

YES, this has happened once before.

This is an ongoing problem.

Briefly describe the incident. *

Any other information we need to know?

Submit

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This form was created inside of West Elk Schools USD 282. Report Abuse

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