Bullying - GFES
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GFES
Items denoted with a red asterisk
*
are required.
1.
Reporting Person:
(optional)
2.
I am a:
*
If other, please specify in the area provided.
I am a:
*
If other, please specify in the area provided.
Student
School employee
Parent/guardian
Person being bullied
Community member
Friend
Other
3.
I have reported this event to my school:
*
I have reported this event to my school:
*
Yes
No
4.
Type of bullying, harassment, or discrimination: (Check all that apply)
*
If other, please specify in the area provided.
Select at least 0 and no more than 0.
Cyber bullying: Takes place in cyberspace. This type of bullying involves various forms of victim harassment, including posting pictures of the victim on websites against his/her wishes and sending pictures through cell phone texting.
Emotional bullying: To exclude the victim from social situations and cause mental pain while leaving the victim feeling alone.
Physical bullying: Injury to the person or his/her belongings is characteristic of this method. The bully may have punched, kicked, shoved, or spit on the victim.
Verbal bullying: The person will say put-downs and rude things directly to the victim, usually in front of his/her friends or peers.
Harassment/Discrimination: Is unwanted, unwelcome and uninvited behavior that belittles, offends and threatens causing one to feel physically or emtionally unsafe. It is based on race, national origin, color, sex, age, disability and/or religion.
Other
5.
Name of Person bullied:
*
This information is required in order to investigate the report.
6.
School person bullied attends:
--None--
Select a School
Baton Elementary
Caldwell Career Center Middle College
Caldwell Eary College High School
Collettsville School
Community
Davenport A+School
Dudley Shoals Elementary
Gamewell Elementary
Gamewell Middle
Gateway High
Granite Falls Elementary
Granite Falls Middle
Happy Valley School
Hibriten High
Horizons Elementary
Hudson Elementary
Hudson MIddle
Kings Creek School
Lower Creek Elementary
Oak Hill School
Sawmills Elementary
School Board
South Caldwell High
Valmead Elementary
West Caldwell High
West Lenoir Elementary
Whitnel Elementary
William Lenoir Middle
7.
Name of person DOING the bullying:
*
This could be a student or adult.
8.
Were you there when the incident occurred?
*
Were you there when the incident occurred?
*
Yes
No
9.
List other students or adults who witnessed the incident:
*
If no witnesses, enter the word "NONE"
10.
Who has been told about the bullying? (Check all that apply)
*
If other, please specify in the area provided.
Select at least 0 and no more than 0.
Teacher
Other adult in school
Parent/guardian
Sibling (brother or sister)
Friend
No one
Other
11.
Where did the bullying occur? (Check all that apply)
*
If other, please specify in the area provided.
Select at least 0 and no more than 0.
Bathroom
Bus stop
Play ground
Athletic field
Gym
Bus
In class with teacher
In class without teacher
Lunchroom
To/From school
Before school
After school
During school
Other
12.
What date did the bullying occur?
*
mm/dd/yyyy
13.
Please describe what happened.
*
Include where and when the incident occurred.
