Report Bullying

Allendale Public Schools

Student Bullying Anonymous Report Form

Please note that this form is completely anonymous.

Bullying vs. Mean/Rude Behavior

When someone says or does something intentionally or unintentionally hurtful ONCE, that's RUDE and MEAN. It is not bullying when two peers with no perceived power imbalance fight, have an argument, or disagree. Conflict resolution or mediation is appropriate for these situations.

When someone does something intentionally hurtful and mean that is repeated and involves and imbalance of power that's BULLYING. Bullying is a form of harassment that can happen to anyone but may be based on race, gender, height, weight, religion, ethnicity, sexual orientation, gender identity, gender expression, familial status, disability or medical condition.

Bullying may be physical (pushing, kicking) verbal (insults, threats), emotional/psychological (spreading rumors, manipulating) and cyber (using the Internet ie. Twitter, Facebook, cell phones to bully others).

Name of victim:

Name of bully:

When did it happen:

What happened (describe in as much detail as possible):

Where did it happen:

Were there any other persons who may have witnessed the bullying? Yes No

If yes, it is optional to name them. Also, list your name if you would like to be contacted.

List your name if you would like to be contacted.

List evidence of bullying, if any (not required), such as letters, photos, e-mails, texts, screen shots and similar items and attach such items below if possible.

Attach Evidence:

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Report Bullying

Allendale Public Schools

Student Bullying Anonymous Report Form

**Please note that this form is completely anonymous.**

Please note that this form is completely anonymous.