Bullying/ Harassment Report Solanco SD

Bullying/ Harassment Report Solanco SD
1. Bullying is characterized by OLWEUS as the following three circumstances:

a) The behavior is aggressive or malicious.
b) It is repeated and goes on over time.
c) It occurs in a relationship where there is an imbalance of strength or power.

2. Cyber bullying is bullying through email, instant messaging (IMing), chat room exchanges, Web site posts, or digital messages or images send to a cellular phone or personal digital assistant (PDA) (Kowalski et al. 2008). Cyber bullying, like traditional bullying, involves an imbalance of power, aggression, and a negative action that is often repeated. ~OLWEUS

3. Harassment: Includes actual or perceived negative actions that offend, ridicule, or demean another individual with regard to race, national origin, marital status, sex, sexual orientation, gender identity, religion, ancestry, physical attributes, socioeconomic status, familial status, physical or mental ability, or disability.

4. Intimidation: Subjecting an individual to intentional action that seriously threatens and induces a sense of fear and/or inferiority.
Name of person completing report:*

First NameLast Name
Email Address*
Relationship to alleged victim(s)*

I am the victimStudentParent/ GuardianClose adult relative of a studentSchool staffBystander
Phone Number*

Area CodePhone Number
Select school of alleged victim(s):*
Name(s) of alleged victim(s):*
Name(s) of witness(es): - (if known)
Name(s) or description of alleged offender(s): - (if known)
On what date did the incident occur?*

MonthDayYear
Date
Were there any other dates that similar instances occurred (if yes, please note)?
Select the statement that best describes what happened (choose all that apply):*

Any bullying, harassment, or intimidation that involves physical aggressionGetting another student to hit or harm the studentTeasing, name-calling, making critical remarks, or threateningDemeaning and making the victim of jokesMaking rude and/or threatening gesturesExcluding or rejecting the studentIntimidating, extorting, or exploitingSpreading harmful rumors or gossipRelated to the student's disabilityRelated to the student's perceived sexual orientationCyber bullying (ex: social media including Facebook, Snapchat, Instagram. etc)Electronic Communication (ex: email, text, sexting, etc.)Racial HarassmentSexual HarassmentSexual in natureOther
Where did the incident happen (choose all that apply)?*

On school propertyOn school busOn the way to/from schoolVia internet - sent on school propertyVia internet - sent off school propertyAt a school sponsored activity or event off school property
Describe the incident(s), including what the alleged offender(s) said or did.*
Why do you think the bullying, harassment, or intimidation occurred?
Is there any additional information you would like to provide?
If available, please upload photos, screenshots, video, or any other related evidence.

Upload a File

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By signing this form, I attest that all information on this form is accurate to the best of my knowledge and I understand the serious nature of this report. By signing this report form, I understand and agree to be contacted by school, local, state, or federal authorities to assist in the matters of this report. (THIS REPORT IS NOT ANONYMOUS.)*
(Retype your name as your signature)
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