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Silence Hurts- Bully Reporting Form
What is the definition of bullying?
A person is bullied when he or she is exposed, repeatedly over time, to negative actions on the part of one or more other persons, and he or she has difficulty defending himself or herself."
If you believe someone at this school is being bullied, according to the definition above, please fill out the following form and submit it so that it can be investigated.
*****Please note that your referral will be kept confidential*****
Name of Student being bullied
*
First
Last
Relationship to the student above
*
Name of Student(s) bullying the above student
Teacher Name
Grade
Please type your concern below:
*
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