Pathways High School
Bullying Report Form
Denison ISD prohibits bullying as defined by policy.
Conduct is considered bullying if it:
1. Exploits an imbalance of power between the student perpetrator and the student victim through written or verbal expression or physical conduct; and
2. Interferes with a student’s education or substantially disrupts the operation of a school.
To obtain assistance and intervention, any student who believes that he or she has experienced bullying or believes that another student has experienced bullying should immediately report the alleged acts to a teacher, counselor, principal, or other District employee.
Name of person filing report
(leave blank if you wish to remain anonymous)
Email of Person Filing Report
Victim's Grade Level
What type of bullying is occuring?
Damage to property
Location of Incident
School-Sponsored activity or event off school property
On the way to/from school
Electronic media (text messages, email, social media, etc.)
Date & Time of the Incident
(List all of the offenders)
Please describe in detail what happened.