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Report Bullying
* Denotes a required field.
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Last Name of Victim*
Please Enter the LAST Name of the Student You Believe is a Victim of Bullying.
First Name of Victim*
Please Enter the FIRST Name of the Student You Believe is a Victim of Bullying
Student/Victim's Campus*
High School
Middle School
Intermediate School
East Ridge
Southeast
Type of Bullying*
Please Check All That Apply Bullying is a behavior that is a written, electronic, verbal, or physical expression that occurs on school property, at a school sponsored/related event, or in a vehicle operated by the district that has or will have the effect of physically harming a student, damaging a student's property, or places the student in reasonable fear of harm or the conduct is sufficiently severe, persistent and pervasive so that it creates an educational environment that is intimidating, threatening, or abusive. Please check any of the below items that apply to this reported situation:
Physical harm or threatening physical harm
Obtaining money or another object of value from an unwilling person or forcing an individual to act
Making ethnic racial religious or other harrassing slurs
Verbal abuse or derogatory or offensive remarks addressed to others
Damaging or vandalizing property of other students
Conduct that constitutes sexual harassment or sexual abuse
Dating violence meaning the intentional use of physical sexual verbal or emotional abuse
Ostracism
Other
Last Name of Reporter
Who is making this report? (Not Required If You Wish to Remain Anonymous)
First Name of Reporter
Who is making this report? (Not Required If You Wish to Remain Anonymous)
Phone Number
Please provide a phone number where you can be reached (Not Required If You Wish to Remain Anonymous)
Description of Incident(s)*
Please describe the bullying incident(s) that you are reporting today.
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