Student Name (required) *

First Name

Last Name

Parent name (if applicable)

First Name

Last Name

Please Tick Applicable (required) *

I am being bullied

My friends and I are being bullied

I have seen someone else being bullied

I am the parent of a child who is being bullied

Type of behaviour displayed/experienced: (Please Tick) *

Isolation/being ignored or left out

Physical/being hit or hurt

Verbal (name-calling, taunting, mocking, threatening)

Cyber (On-line, social media, email, text, posting photos/videos)

Possessions belongings taken or damaged

Physical intimidation or forced into actions against will/hazing

Written

Spreading rumours