Montgomery County Public Schools

Bullying, Harassment, or Intimidation Reporting 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.)

Bullying, Harassment, or Intimidation Reporting Form	179 K	English
Formulario para Reportar Acoso Escolar, Hostigamiento o Intimidación	59 K	Spanish
Formulaire pour Signaler la Brimade, le Harcèlement, ou l’Intimidation	59 K	French
Đơn Báo Cáo Các Hành Động Bắt Nạt, Quấy Nhiễu hay Hăm Dọa	144 K	Vietnamese
霸凌、騷擾或恐嚇事件報告表	254 K	Chinese
약자 괴롭히기/왕따, 희롱 및 협박 행위 보고서	240 K	Korean
የጉልበተኝነት፣ ትንኮሳ፣ ወይም የማስፈራራት ሁኔታ ሪፖርት ማቅረቢያ ቅጽ	455 K	Amharic
Formulário de Denúncia de Bullying, Assédio ou Intimidação	60 K	Portuguese

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