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Lewis & Clark - Anti-Bullying Form
In This Section
Overview
Action Recess Plan
Administrative Policies
Anti-Bullying Report Form
Building Demographics
Building Profile
District Annual Report
Facility Use Request
NDInsights
Parent Mental Health
Report Student Absence
Safe Route to School Map
School Cancellation Process
School Climate and Culture
Schoolwide Plan Public Notification
Student Handbook
Comments/Questions
Lewis & Clark - Anti-Bullying Form
This form requires Javascript to be enabled for submission and authorization.
Describe what happened/what is happening:
When did it happen?
Before school
During school
After school
Unsure
(select approximate time)
Date
Must contain a date in M/D/YYYY format
Time
Where did it happen?
At school
At school event
In school parking lot
On school playground
On the school bus
Online
Other
(select location)
Location details
Who was committing the bullying?
(if you don't know the bully's name(s) describe him/her)
Who was the victim of the bullying?
(if you don't know the victim's name(s), describe him/her)
Did anyone else witness the bullying?
(if yes, please list)
Were you or others physically or emotionally hurt?
(if yes, please explain)
Was there damage to anyone's personal property?
(if yes, please explain)
Have you or the victim missed any school or made any changes to your daily routine as a result of the incident(s)?
Have you told anyone about the bullying?
(example: parent, babysitter, brother/sister, teacher, family member, etc)
Has this happened before?
(if yes, please indicate number of times and details)
Name
First Name
Last Name
Phone Number
Email Address
SUBMIT