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International Falls School District 361 Bullying Conflict OFFICE USE ONLY BULLYING REFERRAL FORM Name Date School/Site 1. Are you a victim or a bystander(witness)? 2. Are you a parent/guardian or
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How to fill out bullying referral form

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How to fill out a bullying referral form?

01
Start by providing your personal details such as your name, contact information, and your current role within the school or organization.
02
Next, provide the details of the victim - their name, age, grade, and any other relevant information you may have. It is important to ensure accuracy in this section.
03
Describe the incident of bullying in detail. Include the date, time, and location of the occurrence. Be as specific as possible and try to provide any witnesses or evidence that may support your claims. Use clear and concise language to accurately depict the situation.
04
Indicate the type of bullying that took place. This can include physical, verbal, emotional, or cyberbullying. Provide clear examples to support your selection.
05
Specify the individuals involved in the incident. Provide the names and relevant details of the bully or bullies, as well as any other witnesses who can support your claims.
06
Explain the impact or consequences of the bullying on the victim. Describe any physical or emotional harm caused, as well as any changes in behavior or academic performance.
07
If any previous incidents of bullying have occurred, make sure to mention them. Include the dates, details, and any actions taken at that time.

Who needs a bullying referral form?

01
School administrators and staff members may require a bullying referral form to properly investigate and address cases of bullying within their institution.
02
Parents or guardians of a child who has experienced bullying may need to fill out a bullying referral form to formally report the incident and ensure appropriate action is taken to protect their child.
03
Students who witness or experience bullying themselves may also need to use a bullying referral form to report the incident and seek intervention or support from school authorities.
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Bullying referral form is a document used to report incidents of bullying, harassment, or intimidation in schools or other settings.
School officials, teachers, parents, or students who witness or experience bullying behavior are required to file a bullying referral form.
The bullying referral form typically includes details of the incident, names of the individuals involved, location, date, and any supporting evidence or witnesses. It should be filled out accurately and submitted to the designated person or office.
The purpose of the bullying referral form is to document and address incidents of bullying, harassment, or intimidation in order to ensure a safe and respectful environment for all individuals.
The bullying referral form must include details of the incident such as names of the individuals involved, date, location, description of the behavior, and any supporting evidence or witnesses.
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