MCPS FORMS > STUDENT FORMS > Bullying, Harassment, or Intimidation Reporting Form

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Bullying, Harassment, or Intimidation Reporting Form

Bullying, harassment, or intimidation are serious and will not be tolerated. This is a form to report alleged bullying, harassment, or intimidation that occurred on school property; at a school-sponsored activity or event off school property; on a school bus; or on the way to and/or from school*, in the current school year. If you are a student victim, the parent/guardian of a student victim, a close adult relative of a student victim, or a school staff member and wish to report an incident of alleged bullying, harassment or intimidation, complete this form and return it to the Principal at the student victim’s school. Contact the school for additional information or assistance at any time. This form is to be confidentially maintained in accordance with the Family Educational Rights and Privacy Act, 20 U.S.C. § 1232g.

• This form is for: Students/Staff/Public
• Form number: 230-35
• Last revised: February 2010
• Related forms: Bullying, Harassment, or Intimidation Incident School Investigation Form (Form 230-36)

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