Online Bullying Reporting Form

Online Bullying Reporting Form

IF YOU ARE IN IMMEDIATE DANGER,
CALL 911.

Barbara Worth Junior High School is committed to providing a safe, comfortable learning environment for all students.
Bullying incidents can be reported directly to a trusted staff member at your school.  This online form may also be used by Brawley Elementary School District Students to report being bullied or by someone witnessing a student being bullied.

WHAT IS BULLYING?
Bullying is unwanted, aggressive behavior among individuals.

Location where incident occured (optional) :

Person Reporting Incident

Name (optional)

Phone (optional)

E-Mail (optional)

Select which apply to you (optional)
Student
Parent/Guardian
School Staff
Community Member

Bullying Incident

Name(s) of alleged offenders (optional)

Please describe the bullying incident. Try to include as many details as possible (optional)

Check all that apply *

VERBAL BULLYING

SOCIAL BULLYING

PHYSICAL BULLYING

TeasingLeaving Someone Out On PurposeHitting / Kicking / Pinching
Name-CallingTelling Other Children Not To Be Friends With SomeoneSpitting
Inappropriate Sexual CommentsSpreading Rumors About SomeoneTripping / Pushing
TauntingEmbarrasing Someone In PublicTaking or Breaking Someone's Things
Threatening to Cause Harm Making Mean Or Rude Hand Gestures
Other :

 

By completing this form, you are verifying that your statements are true and accurate to the best of your knowledge.

If you have trouble completing this form and would like to speak with someone, contact Mrs. Marmolejo at kmarmolejo@besd.org or call 760-344-2153 ext 2099.

 



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