Report Bullies

04/20/2018

Bully Incident Reporting Form

Indiana's Bullying Legislation: IC 20-33-8-0.2 "Bullying" Sec. 0.2 As used in this chapter, "bullying" means overt, repeated acts or gestures, including (1) verbal or written communications transmitted; (2) physical acts committed; or (3) any other behaviors committed; by a student or group of students against another student with the intent to harass, ridicule, humiliate, intimidate, or harm the other student.

Bullying Incident Report Form
Please complete the bullying incident report. This report is anonymous. If you have an immediate concern, please contact the school's administration.

(*) Required

Please select all that apply(*)
Physical - Hitting/kicking/other physical aggression.
Verbal - Teasing, name calling, put-downs, or other behavior that would hurt others' feelings or make them feel bad.
Emotional/Exclusion - Starting rumors, telling others not to be friends with someone or other actions that would cause someone to be without friends.
Cyber-bullying - Using an electronic medium (including but not limited to: texts, e-mails, phone messages, facebook, etc.) to engage in any previously mentioned "bullying."
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Type the name of the student(s) that are bullying and the school they attend.(*)

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Where did the bullying take place?
Jr. Sr. High School
Elementary School
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Name of the student being bullied(*)

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Which school does this student attend?
Jr. Sr. High School
Elementary School
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Description of Events (Please be specific - use exact wording, names, place, time, etc..)(*)

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When did this happen?(*)

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The administrators will investigate the report and take appropriate actions to deal with the situation. Since much of what we do needs to remain confidential, you may not know of the steps we take to stop the bullying. If the bullying does not stop, we need to take additional steps. Please let us know if the bullying continues.

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- Corporation Office
  Pioneer Regional School Corporation
  413 S. Chicago St.
  Royal Center, IN 46978
  
  Mr. Charles Grable, Supt.
  Phone: 574-643-2605
  Fax: 574-643-9977
  
  Jr./Sr. High School
  Pioneer Jr./Sr. High School
  417 S. Chicago St.
  Royal Center, IN 46978
  
  Mr. Jeremy Tucker, Principal
  Phone: 574-643-3145
  Fax: 574-643-2020
- Elementary School
  Pioneer Elementary School
  109 E. Black Lane
  Royal Center, IN 46978
  
  Dr. Beth Dean, Principal
  Phone: 574-643-2255
  Fax: 574-643-4029
Location

Corporation Office

Jr./Sr. High School

Elementary School

Location