Student Concern Form
Conflict: A two-sided issue between students in which both students are contributing to the issue.

Teasing: Involves a sense of play and mutual joking around. There is no intent to harm and is usually done by someone you have a relationship with.

Bullying: Bullying is deliberate or intentional behavior using words or actions, intended to cause fear, intimidation, or harm. Bullying may be a repeated behavior and involves an imbalance of power. Furthermore, it may be serious enough to negatively impact a student's educational, physical, or emotional well being. It includes, but is not limited to such behaviors as stalking, cyber bullying, intimidating, menacing, coercing, name calling, taunting, making threats, and hazing.


Directions: Please answer the following questions as honestly and specifically as you can. The situation will be handled as confidentially as possible.
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Your Name
Date
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DD
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YYYY
Are you the....
What happened?
How long has it been going on?
What have you done to solve the problem yourself?
Have you talked to someone about this?
Clear selection
If you answered yes to the above question, who did you speak to?
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Submit
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