Brimfield CUSD #309 Bullying Reporting Form

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Brimfield CUSD #309 recognizes that all students have the right to be valued and treated with respect and that all students have a responsibility to conduct themselves in a way that respects the safety, health, and property of themselves and others. Towards this end, Brimfield CUSD #309 opposes bullying and encourages all members of the school community (employees, students, and parents) to take the appropriate steps to prevent and respond to bullying behaviors.

The Illinois legislature defines bullying as “Any severe or pervasive physical or verbal act or conduct, including communications made in writing or electronically, directed toward a student or students that has or can be reasonably predicted to have the effect of one or more of the following:

1. placing the student or students in reasonable fear of harm to the student’s or students’ person or property;

2. causing a substantially detrimental effect on the student’s or students’ physical or mental health;

3. substantially interfering with the student’s or students’ academic performance; or

4. substantially interfering with the student’s or students’ ability to participate in or benefit from the services, activities, or privileges provided by the school.” 105 ILCS 5/27-23.7(b)

To report an incident of alleged bullying, harassment, or intimidation, please report directly to the staff at Brimfield Grade School and/or Brimfield High School. If you would prefer, you may complete the form below to begin the process. School staff will follow up on any incidents. Additional information may be required.

Name of person reporting the incident:

Email address:

Alleged victim(s). Please list names. *

Alleged offender(s). Please list name(s), if known. *

Please check the statements that best describe what happened (choose all that apply). *

Any bullying, harassment, or intimidation that involves physical aggression

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

Making rude and/or threatening gestures

Excluding or rejecting the student

Intimidating, extorting, or exploiting

Spreading harmful rumors or gossip

Bullying related to a student's disability

Cyberbullying (e.g. social media including but not limited to Facebook, Twitter, Snapchat, TikTok, Instagram, etc.)

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

Gang related

Racial harassment

Sexual harassment

Other:

Required

Is there any additional information you would like to provide? Please explain more specifics about your report including the most accurate days, times, and what kind of bullying was done. This assists our investigation.

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