Report Bullying/Other Concerns

Please note that these reports are not read immediately after submission but are generally read within 24-hours on regular school days and within 48-hours on the weekend. If you or someone you know is in crisis or in danger, please do not leave a report. Instead, try:

Call the 24-hour, 7 days a week HOPELINE at (800) 784-2433
Send a "text to talk" to 844-670-5838.
Call 911

This will ensure that someone will be able to respond immediately to the emergency situation.

Your Name (Optional, but helpful):

Please understand, without providing your contact information it may be difficult to pursue this report and to inform you of the status of the situation. If you would like to receive an email update on the status of the situation that you have reported you will need to leave your contact information (email) in this section.

Answer required for "Your Name (Optional, but helpful):"

I am a*

Answer required for "I am a"

Victim

Guardian/Family Member

Student Witness

Other:

Describe what happened: Include information on the bully, victim, and witnesses/bystanders; the more detail you provide the better.

Alleged Bully or Offender*

Answer required for "Alleged Bully or Offender"

Alleged Victim*

Answer required for "Alleged Victim"

Witness/Bystanders*

Answer required for "Witness/Bystanders"

What statements best describe what has happened (Choose all that apply)*

Answer required for "What statements best describe what has happened (Choose all that apply)"

Physical Contact

Teasing

Social Exclusion

Stalking/Intimidation

Cyber Bullying

Other:

What statements best describe why you believe the behavior is happening (Choose all that apply)*

Answer required for "What statements best describe why you believe the behavior is happening (Choose all that apply)"

Racial

Sexual Preference

Gender

Other:

Describe the Incident*

Answer required for "Describe the Incident"

Location (Choose all that apply)*

Answer required for "Location (Choose all that apply)"

Off School Property

In A Class

In Hallway

In The Lunchroom

On the way to/from School

On the internet or cellphone (Social Media)

Date and Time this happened

Date*

Answer required for "Date"

Time*

Answer required for "Time"

What sort of help would you like with this issue?*

Answer required for "What sort of help would you like with this issue?"

Would you be receptive to a peer mediation program to solve the current issue?*

Answer required for "Would you be receptive to a peer mediation program to solve the current issue?"

Yes

For more information on Peer Mediation: www.rbhs208.net/peermediation/

If yes, please list both student names:

Answer required for "If yes, please list both student names:"

Have you told anyone else about this incident? (Optional)

Answer required for "Have you told anyone else about this incident? (Optional)"

Additional Information

Answer required for "Additional Information"

Please fix the highlighted areas below before submitting.

Report Bullying/Other Concerns