CMS Safe School

1

CMS Safe School

It is the policy of Mustang Public Schools to prohibit all bullying of any person at school. Bullying means any pattern of harassment, intimidation, threatening behavior, physical acts, verbal communication, or electronic communication directed toward a student or group of students that results in or is reasonably perceived as being done with the intent to cause negative educational or physical results for the targeted individual or group and is communicated in such a way as to disrupt or interfere with the school's educational mission or the education of any student. The purpose of this site is to report bullying, harassment, intimidation, or threats to the safety of Central Middle School students. Please complete the form with as many details as you can provide to facilitate the investigation of the incident. Anonymous reporting is possible however, an anonymous report shall not be the sole basis for formal disciplinary action in response to an incident of bullying.
2
Where did the incident Occur* This field is required.
In Class
In the bathroom
In the hallway
During Lunch
In the parking lot
Through Social Media
at an after school activity
at the bus stop
Other
3
Whate date did the incident occur?* This field is required.
Date
Month
Day
Year
4
What time did the incident happen?* This field is required.
1
2
3
4
5
6
7
8
9
10
11
12
Hour
00
10
20
30
40
50
Minutes
PM
AM
PM
5
How Many times has this situation happened?* This field is required.
This is the first time
One other time
once a month
once a week
every day
6
Have you reported this incident to an adult?* This field is required.
Yes
No
7
Name of the adult to which the incident was reported.
8
Who was the person bullying, harassing, intimidating or causing harm? (Include First Name, Last Name and Grade Level)* This field is required.
9
Who was the person being harmed, bullied, harassed or intimidated? (Include First Name, Last Name and Grade Level)* This field is required.
10
Describe what happened. Give as much information as you can. Please include the names of any witnesses.* This field is required.
11
Which of these words describes you?* This field is required.
Student
Teacher
Staff Member
Volunteer
Parent
Other
12
What is your name (optional)?
Should be Empty: