2022-23 HHS Bullying Form

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

Definitions for bullying, cyberbullying, harassment and intimidation are provided below:

Bullying (page 34) - is an unacceptable pattern of behaviors that should be immediately addressed. Bullying
includes any ongoing physical act(s), threatening communication, or pattern of gestures or communications
that places a student in actual and reasonable fear of harm or is certain to create a hostile or uncomfortable
environment.

Cyberbullying - This differs from generally bullying when there is use of electronic communication to harm or harass others in addition to the above definition of bullying.

Harassment/Intimidation/Threats (page 36) - Any action which is insulting, threatening, abusive, harassing,
profane, obscene or seriously disrespectful, and which disrupts the learning process for any student or
creates a hostile environment in which demeans or degrades another person is specifically prohibited. In
addition, students who leave threatening notes or post on the Internet threats to other students, faculty or
staff will be considered in violation of this rule.

Havelock High School's Assistant Principals address reports of bullying and work with the following student caseloads:

Lea Wedesky - students with last names (A-Gn)
Jessica Fortescue - students with last names (Go-N)
Nannette Walston Moore - students with last names (O-Z)

For more information, please review the CCS Student Policies & Procedures: https://www.cravenk12.org/domain/236

Email *

Last Name *

First Name *

Are you a: *

Student

Parent/guardian of a student

HHS Staff

Other:

Please leave a contact number: *

Please list the victims: *

Please list the offenders: *

Please list any witnesses (If known) *

Select the statement(s) that best describe the incident: (Select all that apply) *

Any bullying, harassment, or intimidation that involves physical aggression

Getting another person to hit or harm the student

Teasing, name-calling, making critical remarks, or threatening, in person or by other means

Demeaning and making jokes about the victim

Making rude and/or threatening gestures

Excluding or rejecting the student

Intimidating (bullying), extorting, or exploiting

Spreading harmful rumors or gossip

Related to the student's disability

Related to the student's perceived sexual orientation

Cyber bullying (e.g. social media including Facebook, Twitter, Tik Tok, Instagram, etc.)

Electronic communication (e.g. email, text, sexting, etc.)

Gang related

Gang recruitment

Hazing

Human trafficking/Prostitution recruitment

Racial harassment

Sexual harassment

Other:

Required

Where did this happen? (Choose all that apply) *

On school property

At a school-sponsored activity

On a school bus or at school bus stop

On the way to/from school

Via Internet - sent on or off school property

Required

Please describe the incident and include what the offender said and/or did. *

Do you know any circumstances that may have contributed to the bullying? *

Did a physical injury result from this incident? *

Yes

Maybe

Unknown

Is there any additional information you would like to provide?

Submit

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