Bullying Reporting Form

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When adults respond quickly and consistently to bullying behavior they send the message that it is not acceptable. Research shows this can stop bullying behavior over time.

Parents, school staff, and other adults in the community can help kids prevent bullying by talking about it, building a safe school environment, and creating a community-wide bullying prevention strategy.

To report an incident of bullying, please fill out the form below.

Please list the names of any victims.

Please list the name of students bullying.

Please list the names of any known witnesses/bystanders.

Date of incident

YYYY

Location of incident (classroom, playground, restroom, bus etc.). Please be as specific as possible.

Type of bullying

Verbal

Physical

Relational

Bulllying behaviors (check all that apply)

Shoved/pushed

Excluded

Staring/leering

Cyberbullying

Hit, kicked, punched

Taunting/ridiculing

Intimidation

Threatened

Writing/graffiti

Demeaning comments

Stole/damaged possessions

Told lies/false rumors

Inappropriate touching

Please describe the incident.

Please list any physical evidence (notes, email, graffiti, video/audio, etc.)

Please list your name and email (optional)

Submit

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This form was created inside of Corryville Catholic Elementary School. Report Abuse

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