Bully Report Form

Wednesday, June 19, 2013

Latest:

	Please provide as much detail as possible to help us deal with the problem effectively.

Name of person being bullied	Please enter the name of the person being bullied.
School	Invalid Input
Date	Please select a date.
Name of bully	Please enter the name of the bully.
Your Name (optional)	Invalid Input

I am a	Student Staff Member Parent/Guardian Person being bullied Community Member Friend Please choose one or more of the following.

Type of Bullying (Select all that apply)	Physical - Hitting/kicking/other physical aggression. Verbal - Teasing, name calling, put-downs, or other behavior that would hurt others' feelings or make them feel bad. Emotional/Exclusion - Starting rumors, telling others not to be friends with someone or other actions that would cause someone to be without friends. Cyber-bullying - Using an electronic medium (including but not limited to: texts, e-mails, phone messages, facebook, etc.) to engage in any previously mentioned "bullying." Please select the type of bullying.

Description of events (Please be specific - use exact wording, names, dates, location and time, etc.):	Please describe the event.

Did you witness the bullying?	YesNo Please specify yes or no.

Please list other students/staff who may have witnessed the bullying incident described above:	Invalid Input

	The administrators will investigate the report and take appropriate actions to deal with the situation. Since much of what we do needs to remain confidential, you may not know of the steps we take to stop the bullying. If the bullying does not stop, we need to take additional steps. Please let us know if the bullying continues.

Get REAL 2013

Visitor's Notice

To contact Staff, choose a school site and click on the "Faculty" menu button.

Web Servant: mahoney@scsc.k12.in.us

Visit Our Schools!

Choose from the menu below to visit the School of your choice.

Tax-deductible contributions may be made to Seymour Community Schools, the athletic department, and the fine arts department. Visit Jackson County Community Foundation for more information.

Contact Us!

Seymour Community Schools
1638 S. Walnut St.
Seymour, IN 47274

Voice: 812-522-3340

Fax: 812-522-8031

CIVIL RIGHTS ASSURANCE OF EQUAL OPPORTUNITY AND NONDISCRIMINATION STATEMENTS:

Seymour Community Schools are committed to equal opportunity and does not discriminate on the basis of age, race, color, sex, handicapping conditions, or national origins including English proficiency, in any employment opportunity. No person is excluded from participation in, denied the benefits of, or otherwise subjected to unlawful discrimination on such basis under any educational program of student activity.

If you have experienced discrimination in such educational programs or activities, written inquires about procedures that are available and for consideration of complaints alleging such discrimination should be directed to the Director of Curriculum/Title IX Director/504 Director, Seymour Community Schools, 1638 S. Walnut Street, Seymour, IN 47274 or call 812-522-3340.

Get REAL 2013

Visitor's Notice

Visit Our Schools!

Contact Us!

Login