SAMHS HIB Parent Reporting Form
In accordance with the revised law signed by Governor Murphy on January 10, 2022, South Amboy Public Schools must provide an opportunity for parents to submit an anonymous report of HIB through the school website. This form was created to collect the timestamp of when the form was submitted and does not collect the email address of the sender or their IP address.

According to Board of Education Policy 5131.1 and the Antibullying Bill of Rights in order for an incident to be classified as a harassment, intimidation, or bullying the following definition must be met.

Harassment, intimidation or bullying” is defined as any gesture, any written, verbal or physical act, or any electronic communication, whether it be a single incident or a series of incidents, that...
  • ...is reasonably perceived as being motivated either by any actual or perceived characteristic, such as race, color, religion, ancestry, national origin, gender, sexual orientation, gender identity and expression, or a mental, physical or sensory disability, or by any other distinguishing characteristic...
  • ...that takes place on school grounds, at any school-sponsored function or on a school bus, or off school grounds, in accordance with the law... AND
  • that substantially disrupts or interferes with the orderly operation of the school or the rights of other students
The event also must meet one of the following areas:
  • A reasonable person should know, under the circumstances, will have the effect of physically or emotionally harming a student or damaging the student’s property, or placing a student in reasonable fear of physical or emotional harm to his/her person or damage to his/her property; or
  • Has the effect of insulting or demeaning any student or group of students; or
  • Creates a hostile educational environment for the student by interfering with the student’s education or by severely or pervasively causing physical or emotional harm to the student.MH
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I have read the definition listed above and understand that by completing this form an investigation might occur if a preliminary determination is made to proceed. *
The information that I am about to provide in this report to the best of my knowledge is accurate and truthful. *
Required
Prior to submitting this form did you communicate the issue to the classroom teacher, school counselor, or building principal? *
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