CMS Confidential Bullying Report
This report will be submitted to a Crawfordsville Community School Corporation administrator and will be kept confidential. Fields marked with an asterisk * are required.
Does what happened fit all 3 parts of the definition of bullying? All three must be present to be submitted.
It is repeated.
There is an imbalance of power.
The person is being mean on purpose.
Do all three fit the incident?
Please fill out the form with the most accurate and complete information.
Name of Reporter
Your name will be kept confidential.
You are the
Target - (Being Bullied)
Reporter - (Not the Target)
You are a(n)
Reporter Phone #
Please include an email address
Name of Target(s)
Student(s) Exhibiting Bullying Behavior
Date and Time of Incident
Location of Incident
Please describe the incident with details including names of persons involved, what occured, and who did what. Please include specific language used and actions taken.
(People who saw or may have seen the incident or who may have relevant information.)
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