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Bullying Complaint Form
Bullying is intentional, harmful behavior initiated by one or more students and directed towards another student.  Bullying exists when a student with more social and/or physical power deliberately dominates and harasses another who has less power.  Bullying is unjustified, unprovoked and typically repeated.

Date of Report
Name of person riling the report: (Insert name or type "anonymous" if you are not willing to disclose your name.)
Alleged Target(s) of Bullying Please type the names of students who are being bullied.
Date, time & location of the incident: Please provide specific details as to when and where the bullying is occurring:
Witnesses: (Please enter the names of any witnesses to the bullying behavior.)
Details Please describe the bullying incident in as much detail as possible:
Is this the first time this has happened?
Were any adults made aware of this incident? Please type the names of any adults who were made aware of this incident:

To validate your submission, please type the answer to the following question:

10 Keibel Rd. Whitney Point, NY 13862  |  P 607.692.8202  |  F 607.692.4434
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