Online Bullying Report

Bullying as defined by IC 20-33-8-0.2 means overt, unwanted, repeated acts or gestures, including verbal or written communications or images transmitted in any manner (including digitally or electronically), physical acts committed, aggression, or any other behaviors that are committed by a student or group of students against another student with the intent to harass, ridicule, humiliate, intimidate, or harm the targeted student and create for the targeted student an objectively hostile student environment

If you feel bullying is taking place, Please complete the form below. Name and email are optional.

Name (optional)

First Name

Last Name

Email (optional)

Phone

(###)

###

####

I am a:

Date of Incident

MM

DD

YYYY

Name of Student being Bullied

First Name

Last Name

Name of Alleged Offender

First Name

Last Name

Type of bullying (check all that apply)

Verbal

Physical

Social/Relational

Written or Electronic

Brief explanation of the incident:

Where did the bullying happen?

Did a physical injury result from this incident?

If any medical attention was required, please briefly explain.

Was the target of the incident absent from school as a result?

If yes, for how many days?

Please provide any other information you would like to provide in order to help our investigation