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.
Grade of student(s) who were 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: