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Bullying, Harassment, or Intimidation Reporting Form

About this Form

Form number: 230-35

Audience:  Students

Last revised: August 2022

Related Forms

Form 230-36 - Bullying, Harassment, or Intimidation Incident School Investigation Form

DIRECTIONS: The Bullying, Harassment or Intimidation Reporting Form should be used to report alleged incidents of bullying, harassment, or intimidation that occurred during the current school year on school property, at a school-sponsored activity or event off school property, on a school bus, on the way to and/or from school, or through personal mobile device on or off school property. School staff will address incidents that occur at school or have a connection or nexus back to the school setting that create a risk of harm to other students while they are at school or interfere with the educational environment.

If you are a student, the parent/guardian or a family member of a student, a school staff member, or a bystander and wish to report an incident of alleged bullying, cyberbullying, harassment, or intimidation, please complete this form and return it to the school principal.

You may contact the school for additional information or assistance at any time. (Bullying, cyberbullying, harassment, and intimidation definitions are provided below.)

Adobe PDF Bullying, Harassment, or Intimidation Reporting Form179 KEnglish
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