BULLY REPORTING FORM

Definition of Bullying or Peer Intimidation: Is defined as any act or behavior in order to hurt another person in any way. Bullying or intimidation is characterized by an individual behaving in a certain way to gain power over another person (Besag, 1989).  Behaviors that are repetitive and may include name calling, verbal or written abuse, exclusion from activities, exclusion from social situations, physical abuse, or coercion should be reported.

***THIS SITE IS FOR THE USE OF THOSE IN OUR LMS COMMUNITY***


Items denoted with a red asterisk * are required.
Your First & Last Name
 

OPTIONAL
 * Date of Incident
 
Click to View Date Picker
 * Time
 
(hh:mm am/pm)
 * Frequency of bullying
 
Describe "Other"
 
Where did the incident occur?
 
 * Describe the incident
 
Please list a person who can be contacted for more information.
 
 
 
Understand that filing a false report in Kansas is a crime
Kansas State Statute 21-3818 Falsely reporting crime

a) Falsely reporting a crime is informing a law enforcement officer or state investigative agency that a crime has been committed, knowing that such information is false and intending that the officer or agency shall act in reliance upon such information.

b) Falsely reporting a crime is a class A nonperson misdemeanor