Skip to Main Content
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 Name (Person Completing Form):
*
Your Role:
*
ReportersRole
Student
Parent/Guardian
Community Member
Employee
Your Telephone Number:
*
Your Telephone Number:
*
Your Email Address:
*
Your Email Address:
*
Victim's First Name:
*
Victim's First Name:
*
Victim's Last Name:
*
Victim's Last Name:
*
Victim's Student ID:
Victim's Student ID:
Victim's school:
*
Victim's school:
*
Aslin Administration Building
CORE
Alpha Hart Lewis Elementary School
Benton STEM Elementary School
Beulah Ralph Elementary
Blue Ridge Elementary School
Cedar Ridge Elementary School
Center for Early Learning North
Columbia Area Career Center
Derby Ridge Elementary School
Douglass High School
Elementary Virtual
Eliot Battle Elementary
Eugene Field Center
Eugene Field School
Fairview Elementary School
Gentry Middle School
Grant Elementary School
Hickman High School
Jefferson Middle School
John Warner Middle School
Juvenile Justice Center
Lange Middle School
Locust Street Expressive Arts Elementary School
Mary Paxton Keeley Elementary School
Midway Heights Elementary School
Mill Creek Elementary School
Muriel Battle High School
New Haven Elementary School
Oakland Middle School
Parkade Elementary School
Ridgeway Elementary School
Rock Bridge Elementary School
Rock Bridge High School
Russell Boulevard Elementary School
Shepard Boulevard Elementary School
Smithton Middle School
Two Mile Prairie Elementary School
West Boulevard Elementary School
West Middle School
Name of person(s) you believe committed bullying:
*
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)
*
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:
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:
*
Enter the date of alleged incident(s), in month month dash date date dash year year year year format:
*
Where did the incident(s) occur?
*
OffenseLocation
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 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.
Please provide other information relevant to this incident of bullying.
g-recaptcha-response