Bullying Report

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If you believe this incident is an emergency or could cause immediate
harm to yourself or others and needs immediate attention, please call 911.
For non-emergencies, you can also call the Speak Out Hotline at
1-800-423-TIPS (1-800-423-8477).

This form should be used to report a possible incident of bullying as defined in the Osceola County School District Policy against bullying and harassment.

Stop Bullying NowBullying is systematically and chronically inflicting physical hurt or psychological distress on one or more students or employees and may involve but is not limited to teasing; social exclusion; threat; intimidation; stalking, including cyberstalking; physical violence; theft; sexual, religious, or racial harassment; public humiliation; and destruction of property.  An easy way to remember this definition is: Repetitive, Intentional, and an imbalance of Power.

For more information about bullying, click here.  (go to www.stopbullying.gov)

 

School Name:

Name (Optional)

First:

Last:

Contact Information (Optional):

Address 1:

Address 2:

         City :

       State :

  Zip Code:

     Phone :

     E-mail :

Describe the bullying incident: (Include Dates)

List the person(s) involved:

Where did the bullying take place?

How often has the bullying behavior occurred?

Have you reported the bullying incident to anyone?

Yes

No

If Yes, who?

Is there any other information you would like to provide?

 


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