Please make sure that all the required fields are filled out to the best of your ability. The more detail you give, the easier it will be for the school to address these behaviors. If you believe this to be an emergency, please see a teacher, counselor, or administrator immediately.
Please remember that in a written instrument, any student who knowingly makes a false statement which such person does not believe to be true has committed the code of conduct infraction of lying to school personnel.
What will happen next?
An administrator or counselor will review your report and you will be contacted promptly. Your identity will not be revealed to the person whose behaviors concern you, and you will not have to meet with him or her unless you make that choice.
A safety plan you can start right away:
Tell the person to stop in a loud voice to draw attention and get away as best you can.
For the time being, try to avoid areas where you might encounter that person.
Keep a record of what has been happening.
In the case of cyber-bullying, print or write down information that you recall.
Keep evidence: damaged property, emails, text messages, etc.
Do not blame yourself and stay cool.
Feel free to go into any teacher’s classroom if you feel threatened.
Allow your teacher or guidance counselor to email your other teachers to be looking out for you.
Tell others that you are having a difficult time. People are here to help.
Adopted: _____