Bullying Reporting Form

Kennett High School is committed to providing all students a safe and secure educational environment.  Conduct constituting bullying and/or cyberbullying will not be tolerated and is hereby prohibited.  This form is to report alleged bullying incidents and submissions will be forwarded to the school administration for review.

 In accordance with RSA 193-F:3, bullying is defined as a single significant incident or a pattern of incidents involving a written, verbal, or electronic communication (i.e. cyberbullying), or a physical act or gesture, or any combination thereof, directed at another student.

 In accordance with RSA 193-F:4, the Conway School District reserves the right to address bullying and, if necessary, impose discipline for bullying that: occurs on, or is delivered to, school property or a school-sponsored event on or off school property (including school buses); or occurs off school property or outside of a school-sponsored activity or event, if the conduct interferes with a student’s educational opportunities or substantially disrupts the orderly operations of the school or school-sponsored activity or event.

 
Name of Person Reporting Incident
Telephone Number of Person Reporting Incident
Email Address of Person Reporting Incident
I am a ...
 
 
 
 
Student Victim's Name
Student Victim's Grade
 
 
 
 
Name of Alleged Offender(s)
On what date did the incident happen?
 
 
 
Where did the incident(s) happen? Choose all that apply.
 
 
 
 
 
 
What did the alleged offender(s) say or do? Be as specific as you can.
Do any adults in the building know about this?
 
 
Were there any witnesses?
 
 
Is there any additional information you would like to provide?
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