Report Bullying, Harassment and Discrimination

“Bullying or Harassment behavior is any pattern of gestures or written, electronic or verbal communications or any physical act or any threatening communications that: 1) places a student or school employee in actual and reasonable fear of harm to his or her person or damage to his or her property; or 2) creates or is certain to create a hostile environment by substantially interfering with or impairing a student's educational performance opportunities or benefits.  Discrimination means any act or failure to act that unreasonably and unfavorably differentiates treatment of others based solely on their membership in a socially distinct group or category, such as race, ethnicity, sex, pregnancy, religion, age or disability.  Discrimination may be intentional or unintentional.” 

Harassment, bullying or discrimination can occur face to face, in writing, through the Internet, emailing or text messaging.  Caldwell County Schools takes these offenses very seriously and they will not be tolerated!  If you have experienced or witnessed any of these types of behavior, we encourage you to tell a teacher, counselor, principal or other school personnel.  If you prefer to make your report in writing, you may use this form. Please note providing your name is optional.   



Items denoted with a red asterisk * are required.
Reporting Person:
 

(optional)

 * I am a:
 








If other, please specify in the area provided.

 * I have reported this event to my school:
 

 * Type of bullying, harassment, or discrimination: (Check all that apply)
 






If other, please specify in the area provided.

 * Name of Person bullied:
 

This information is required in order to investigate the report.

 * School person bullied attends:
 
 * Name of person DOING the bullying:
 

This could be a student or adult.

 * Were you there when the incident occurred?
 


 * List other students or adults who witnessed the incident:
 

If no witnesses, enter the word "NONE"

 * Who has been told about the bullying? (Check all that apply)
 







If other, please specify in the area provided.

 * Where did the bullying occur? (Check all that apply)
 














If other, please specify in the area provided.

 * What date did the bullying occur?
 
Click to View Date Picker
 * Please describe what happened.
 

Include where and when the incident occurred.

Please enter the text
to the right