Richland-Bean Blossom Community School Corporation Bullying Form: Please complete all of the areas below that you can. Information that is (*) starred is required. Thank you.

Who Are You?

Person Reporting Bullying (First Name and Last Name)(*)

Please let us know your name.

When did the bullying happen?(*)

Tell us when it happened.

Who Was Bullied?

Who do you think was bullied? (First Name and Last Name)(*)

Please let us know the bully's name.

Where does this person attend school?

Invalid Input

Who is this person's teacher?

Please write a subject for your message.

What grade?

Who Is The Bully (or Bullies)?

Who do you think was bullying?(*)

Please let us know the person's name.

What grade?

Please let us know your name.

Type of Bullying (check all that apply)(*)

Select one type.

Where did the bullying happen? (check all that apply)(*)

Tell us where the bullying happened.

Other Information

Is this the first time that this has happened?(*)

Please answer this question.

Have you filed a Student Bullying Report before?(*)

Please answer this question.

Who has been told about the bullying or saw what happened? (check all that apply)(*)

Please tell us this.

Any other information that you would like to share?

Our mission is to work in cooperation with the community and families to provide students with an education that promotes responsible citizenship and encourages problem solving and creativity.