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Bullying Report Form

Prince George County Public Schools encourages students, families, and community members to report bullying concerns so we can take timely, appropriate action.

This form provides a safe way to share information that may help us support those involved and improve the school environment.

Please note that submissions are not monitored continuously. If you believe someone is in immediate danger or there is an imminent threat to the safety of a student, staff member, or others in the community, contact 911 or law enforcement right away or submit an anonymous safety tip through P3Tips.

Bullying Defined:
Bullying means any aggressive and unwanted behavior that is intended to harm, intimidate, or humiliate the victim; involves a real or perceived power imbalance between the aggressor or aggressors and victim; and is repeated over time or causes severe emotional trauma. Cyberbullying means bullying that occurs through the use of technology, including through cell phones and other electronic devices or technology capable of accessing the Internet.

Bullying does not include ordinary teasing, horseplay, argument, or peer conflict.

Please complete the form below. Required fields marked with an asterisk *

Date of Incident

Answer required for "Date of Incident"

Time of Incident

Answer required for "Time of Incident"

Location of Incident*

Answer required for "Location of Incident"

Name(s) or Description of Alledged Victim(s)

School Student Attends*

Answer required for "School Student Attends"

Name or Description of Alleged Victim #1*

Answer required for "Name or Description of Alleged Victim #1"

Name or Description of Alleged Victim #2

Answer required for "Name or Description of Alleged Victim #2"

Name or Description of Alleged Victim #3

Answer required for "Name or Description of Alleged Victim #3"

Name(s) or Description of Alleged Bully(ies)

School Student Attends*

Answer required for "School Student Attends"

Name or Description of Alleged Bully #1*

Answer required for "Name or Description of Alleged Bully #1"

Name or Description of Alleged Bully #2

Answer required for "Name or Description of Alleged Bully #2"

Name or Description of Alleged Bully #3

Answer required for "Name or Description of Alleged Bully #3"

Name(s) of Witness(es) / Bystander(s)

School Student Attends

Answer required for "School Student Attends"

Witness/Bystander #1

Answer required for "Witness/Bystander #1"

Witness/Bystander #2

Answer required for "Witness/Bystander #2"

Witness/Bystander #3

Answer required for "Witness/Bystander #3"

Bullying Behaviors

Please check all the bullying behaviors that apply.*

Answer required for "Please check all the bullying behaviors that apply."

Physical

Emotional

Cyberbullying

Did the person(s) do it on purpose?*

Answer required for "Did the person(s) do it on purpose?"

Yes

Has this happened more than once, or do you think it might happen again?*

Answer required for "Has this happened more than once, or do you think it might happen again?"

Yes

Did the student who was picked on felt like they couldn't stop it or get help? (For example, was the other person bigger, stronger, more popular or had more power in some way?)*

Answer required for "Did the student who was picked on felt like they couldn't stop it or get help? (For example, was the other person bigger, stronger, more popular or had more power in some way?)"

Yes

Describing the bullying incident.*

Answer required for "Describing the bullying incident."

Person Reporting Incident
If you wish to submit your report anonymously, please select "Yes" below and leave the first and last name spaces empty.

First Name

Answer required for "First Name"

Last Name

Answer required for "Last Name"