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Bullying Report Form

Required

Bullying incidents can be reported anonymously.

Bullying is defined as any intentional gesture or any intentional written, verbal, electronic or physical act or threat that is sufficiently severe, persistent, or pervasive that creates an intimidating, threatening, or abusive educational environment for a student or staff member that reasonable person, under the circumstances, knows or should know, will have the effect of:  
 

  • Harming a student or staff member
  • Damaging a student or staff members property
  • Placing a student or staff member in reasonable fear of harm to the student or staff member
  • Placing a student or staff member in reasonable fear of damage to the student’s or staff member’s property

K.S.A. 72-8256

Must contain a date in M/D/YYYY format
Where did the incident happen? Please choose all that apply:required
Were there any witnesses?required
Did a physical injury result from this incident?required
Was the victim absent from school as a result of the incident?required
Must contain a date in M/D/YYYY format
Name of Person Reporting (Optional)
First Name
Last Name