Richland-Bean Blossom Community School Corporation Bullying Form: Please complete all of the areas below that you can. Information that is (*) starred is required. Thank you.

Who Are You?

Person Reporting Bullying (First Name and Last Name)(*)

Please let us know your name.

When did the bullying happen?(*)

Tell us when it happened.

Who Was Bullied?

Who do you think was bullied? (First Name and Last Name)(*)

Please let us know the bully's name.

Where does this person attend school?

Invalid Input

Who is this person's teacher?

Please write a subject for your message.

What grade?

Who Is The Bully (or Bullies)?

Who do you think was bullying?(*)

Please let us know the person's name.

What grade?

Please let us know your name.

Type of Bullying (check all that apply)(*)

Select one type.

Where did the bullying happen? (check all that apply)(*)

Tell us where the bullying happened.

Other Information

Is this the first time that this has happened?(*)

Please answer this question.

Have you filed a Student Bullying Report before?(*)

Please answer this question.

Who has been told about the bullying or saw what happened? (check all that apply)(*)

Please tell us this.

Any other information that you would like to share?

Edgewood Junior High School Vision Statement

At EJHS we promote: Creativity, Optimism, Learning, Togetherness, Success, in a united effort to provide all students with social, academic, and real-world skills.

Edgewood Junior High School Mission Statement

Edgewood Junior High School is a disciplined environment dedicated to developing lifelong learners.