The form below is provided for you to inform BCCHS about any situation or problem that you are having or know information about regarding being bullied or harassed. This can apply to you as a victim or an incident that you have withnessed. Bullying is an act that is done on purpose. Bullies use their power (physical size, age, social status, technology skills, etc.) to threaten, harass, or hurt others. Bullying happens over and over to one person or a group of people. Bullying happens in four basic ways: physical (punching, pushing, stealing), verbal (name-calling), indirect (leaving someone out on purpose), and cyber (use of technology). These situations can occur in school or out of school. Please provide as much information as possible so that the problem can be addressed directly and effectively. Silence is Acceptance!
FALSE REPORTING OF AN INCIDENT IS AGAINST SCHOOL POLICY

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* 1. I am a:

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* 2. Name (optional, but helpful)

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* 3. Name of victim(s):

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* 4. Name(s) of alleged offender(s):

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* 5. Where did the incident happen (check all that apply):

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* 6. Estimated date and time of the incident:

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* 7. Has the incident been reported to anyone yet?

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* 8. Were there any witnesses?

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* 9. Please describe in detail what happened:

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* 10. Please provide any other information or comments that may be beneficial to resolving the issue.

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