EmailMe Form - BULLYING REPORT

BULLYING REPORT

"A person is a victim of bullying when he or she is exposed REPEATEDLY and OVER TIME, to NEGATIVE ACTIONS on the part of ONE OR MORE PERSONS, and he or she has DIFFICULTY DEFENDING him or herself."

Name
Grade *
Teacher *
Are you a Johnson Elementary School student? *
Yes
No
How many times has this happened? *
1 or 2
3 or 4
5 or more
What negative actions happened? *
Where did this happen? *
When did it happen? *
Today
Yesterday
This week
This month
Earlier this year
How have you handled this situation thus far? *
told your teacher
told another adult at school
told a parent or adult at home
responded with an "I" statement
walked away or ignored behavior
other
If you selected "other" in the previous question please let us know how you addressed the concern.

Powered by

EMF Form Builder