Southern Middle School

Garrett County Public School
Oakland, Maryland


Southern Middle School
Anonymous Bulling Form

 

Bullying, harassment, or intimidation are serious and will not be tolerated at Southern Middle School. This is a form to report alleged bullying, harassment, or intimidation that occurred on school property; at a school-sponsored activity or event off school property; on a school bus; or on the way to and/or from school.

Name of student victim

Name(s) of alleged offender(s)

  


        
     Other time                                               Other place
        

   Date(s)      

Select the statement(s) that best describes what happened (choose all that apply):

   Any bullying, harassment, or intimidation that involves violent behavior
   Persuading another student to hit or harm the student
   Name-calling, making critical remarks, threatening, or teasing, in person or by other means
   Spreading harmful rumors or gossip
   Making rude and/or threatening gestures
   Intimidating, extorting, or exploiting
   Electronic communications (how)
   Other

Brief description



“Electronic communication” means a communication transmitted by means of an electronic device, including a telephone, cellular phone, computer, or pager.

Have your told anyone? Yes          No

Who?

What can we do to help?