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'Speak Up to Stop Bullying' Form
Bullying is defined now as written or oral expression or physical conduct that is determined to: 1. Have the effect of physically harming a student, damaging a student's property, or placing a student in reasonable fear of harm to the person or person's property. 2. Be sufficiently severe, persistent, or pervasive to create intimidating, threatening, or abusive educational environment for a student. This conduct is considered bullying if it: 3. Exploits an imbalance of power between the student perpetrator and the student victim through written or verbal expression or physical conduct; and 4. Interferes with a student's education or substantially disrupts the operation of a school.
Campus:
Date of incident: (mm/dd/yyyy)
Date of report: (mm/dd/yyyy)
Person bullying:
Grade of person bullying:
Person being bullied:
Grade of person being bullied:
List any bystanders/witnesses:
Type of bullying:


Where did the incident take place?













If other selected, please list location:
When did it take place?
Describe what happened. Give as many details as possible.
List evidence of bullying if any (letters, photos, text messages, etc.)
Person making report (optional):

The mission of Hawley ISD is to produce responsible, productive citizens by providing a competent staff who will teach a diverse curriculum in a safe, structured, and nurturing environment.

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