Policy on Bullying
Name of Victim Victim's Campus ---BETAMedical AcademyMed HighRising ScholarsSci TechSTPA Grade --070809101112
Date Location --ClassroomHallwayCafeteriaBusGymOutsideOnlineOther
Name of Alleged Bully
Grade of Alleged Bully ---070809101112
What happend?
Did anybody else witness what happened? ---YesNo
If Yes, who?
How long has this been happening? Has this been reported before? --YesNo
HAS ANYONE BEEN NOTIFIED? ---YesNo
Parent Name
Teacher/Counselor Name
Principal/Asst. Principal Name
Others
Your Name (Optional)
Is it okay someone contacts you? --YesNo
If yes, please proved email or phone number