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.
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:
(Please enter the names of any witnesses to the bullying behavior.)
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: