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Harassment, Intimidation, Hazing, and Bullying Report

Required

Reporter's Information

Name of Person Reporting the Incidentrequired
First Name
Last Name

Incident Information

If the incident has happened multiple times, please select the most recent date. (Must contain a date in M/D/YYYY format)

Types of Harassment, Intimidation, Hazing, and Bullying

Physical involves hurting a person’s body or possessions. Physical includes:

  • Hitting/kicking/pinching

  • Spitting

  • Tripping/pushing

  • Taking or breaking someone’s things

  • Making mean or rude hand gestures

Verbal means saying or writing mean things. Verbal includes:

  • Teasing

  • Name-calling

  • Inappropriate sexual comments

  • Taunting

  • Threatening to cause harm

Social, sometimes referred to as relational, involves hurting someone’s reputation or relationships. Social includes:

  • Leaving someone out on purpose

  • Telling other children not to be friends with someone

  • Spreading rumors about someone

  • Embarrassing someone in public

Cyberbullying is bullying that takes place using electronic technology. Examples of cyberbullying include:

  • Mean text messages or emails

  • Rumors sent by email or posted on social networking sites

  • Embarrassing pictures, videos, websites, or fake profiles

 

More information at stopbullying.gov


 

Type of harassment, intimidation, hazing, bullying, or harm:Please select up to 4 choices
Please select up to 4 choices
Name of Victimrequired
First Name
Last Name
Name of Offender(if known)
First Name
Last Name
(if known)
(if known)
Please give as much information as you can about the incident, including witnesses & exact details.
Aknowledgementrequired