Report a Bully

Make sure that what you report is accurate and not hearsay. Hearsay is a rumor: gossip (usually a mixture of truth and untruth) passed around by word of mouth. To be accurate you must have either witnessed the event(s) or have been told about them either from the actual person being bullied or by the actual bully.

	I have reported this event to my school:
	YesNo

	WHO got Bullied? Please give first name, last name and grade level. We can't follow up without this person's name.

	Please describe what happened. Please include where and when it occured:

	When did the Bullying occur?

	Who was DOING the Bullying? Please include first and last name and grade level.

	Your first and last name (optional):

Type of Bullying (Select all that apply):
Select at least 0 and no more than 0.

Physical Bullying - Injury to the person or his or her belongings is characteristic of this method. The bully may have punched, kicked, shoved, or spit on the victim.

Cyber Bullying - takes place in cyberspace. This type of bullying involves various forms of victim harassment, including posting pictures of the victim on websites against his or her wishes and sending pictures through cell phone texting.

Emotional Bullying - to exclude the victim from social situations and cause mental pain while leaving the victim feeling alone.

Verbal Bullying - the person will say put-downs and rude things directly to the victim, usually in front of his or her friends.

Other, please specify

	Were you there when this happened?
	YesNo

	List other students or adults who witnessed the event: