Translate here / Traducir aquí / 번역은 여기를 참조하십시오 / 翻译在这里 / Tafsiri hapa / Sobanura hano / Traduire ici / ترجمة هن



Clicking "Submit Bullying Incident Report" indicates your authorization to provide this information to Columbia Public Schools.
NOTE: Employees are required to file this form with the building principal within TWO (2) School Days of the incident.

Your Name (Person Completing Form): *

Your Role: *
Student Parent/Guardian Community Member Employee

Your Telephone Number: *

Your Email Address: *

Victim's First Name: *

Victim's Last Name: *

Victim's Student ID:

Victim's school: *

Name of person(s) you believe committed bullying: *

State the nature of your report. Please describe the action(s)/incident(s) you believe may be in violation of the District's anti-bullying policy as clearly as possible, including such things as what physical force or contact, if any, was used and any verbal statements that were made (i.e. threats, requests, demands, etc.). Definitions of 'bullying', 'hazing', and 'cyberbullying' under Board Policy JFCF can be found by clicking here.(opens in a new tab) *



Check this box if the nature of your report includes actions that may be considered sexual harassment.
Definitions of sexual harassment can be found in board policy. Non-Title IX Board Policy AC(opens in a new tab); Title IX - Board Policy ACA(opens in a new tab)

If others are affected by this possible violation, please also give their names and/or positions:

Enter the date of alleged incident(s), in mm-dd-yyyy format: *

Where did the incident(s) occur? *
On School Property School Bus During School Event/Function Off of School Property
Digital Communication

Please list any witnesses who were present, or others who may have information regarding the incident(s):

Please provide other information relevant to this incident of bullying.
 



 
CPS Contact Info 573-214-3400