Bullying
Bullying Incident Report Form for Use by Parents, Students, and Community Members.

Definition of bullying:

Bullying is defined as follows by Missouri Statute:

Bullying – In accordance with state law, bullying is defined as intimidation, unwanted aggressive behavior, or harassment that is repetitive or is substantially likely to be repeated and causes a reasonable student to fear for his or her physical safety or property; that substantially interferes with the educational performance, opportunities or benefits of any student without exception; or that substantially disrupts the orderly operation of the school. Bullying includes, but is not limited to: physical actions, including violence, gestures, theft, or property damage; oral, written, or electronic communication, including name-calling, put-downs, extortion, or threats; or threats of reprisal or retaliation for reporting such acts.

It is important to distinguish bullying from other unkind, mean and harmful behavior. Calling someone a name or pushing someone once, being rude or having an argument with someone is not bullying. Of course, these behaviors should be addressed but may have different consequences and interventions, which is why the distinction is critical. To be defined as bullying, all three components must be present: (1) repeated actions or threats, (2) a power imbalance and (3) intention to cause harm. If bullying is identified correctly, there are various ways to address it.

https://www.adl.org/education/resources/tools-and-strategies/table-talk/what-bullying-is-and-is-not

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Reporter (Person Filing the Report)
Date Filed
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First and Last Name:
Address:
Phone Number:
Email Address:
Relationship to the student being bullied (parent/guardian,fellow student, community member, etc:
I prefer to remain anonymous.  (The district will investigate all allegations of bullying, but it is more difficult to follow up on anonymous reports.)
Bullying frequently involves repeated behavior.  If you have witnessed or have knowledge of more that one incident, please provide information on all incidents.  Please feel free to use multiple forms or attach additional pages if necessary to report all related incidents.
Did you witness this incident?  
If no, provide specific information as to how you found out about this incident:
Details of Incident
What is the approximate date that this incident occurred?
MM
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DD
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YYYY
What is the approximate time that this incident occurred?
Time
:
Where did the incident take place? (Be as specific as possible . For example, instead of "the middle school. " specify "the sixth-grade men's bathroom at the middle school."
Please provide the name of the student or students who were the target of the bullying and include Grade Level and the School of Attendance:
Please provide the name of the student or students who were engaging in the bullying behavior and include Grade Level and School of Attendance.:
List the names of others who witnessed or may have witnessed the incident:
Please describe the incident.  (Include as much detail as possible.  Do not "clean up" anything that was said or done.  If inappropriate language or gestures were used, include the exact language and describe the exact gesture used.)
Is there any other information you believe is relevant for the district to know when investigating this incident?
This report should be accompanied by any applicable evidence that bullying occurred, such as copies of notes, emails or photos.  If the bullying includes sexting, nudity, or inappropriate images of a minor, please d NOT copy, download or further distribute the images!  Instead, show the evidence to the principal immediately so that appropriate action can be taken.
Once submitted, this form will be forwarded to the appropriate staff member for further action.
Administrator's Report(Admin  Only)
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