**PLEASE NOTE: Any form components that do not have a red asterisk (*) next to them are NOT required for reporting.**
Any intentional gesture or any intentional written, verbal, or physical act or threat that is sufficiently severe, persistent, or pervasive that creates an intimidating, threatening or abusive educational environment for a student or staff member that a reasonable person, under the circumstances, knows or should know will have the effect of:
1. Harming a student or staff member, whether physically or mentally;
2. Damaging a student's or staff member's property;
3. Placing a student or staff member in reasonable fear of harm to the student or staff member; or
4. Placing a student or staff member in reasonable fear of damage to the student's or staff member's property; or
5. Cyberbullying which means bullying by use of any electronic communication device through means including, but not limited to, e-mail, instant messaging, text messages, blogs, mobile phones, pagers, online games and Web sites.
