200-RICR-30-10-2
A. “Bullying” means:
1. The use by one or more students of a written, verbal or electronic expression or a physical act or gesture or any combination thereof directed at a student that:
2. The expression, physical act or gesture may include, but is not limited to, an incident or incidents that may be reasonably perceived as being motivated by characteristics such as:
B. “Cyber-bullying” means:
2. Forms of cyber-bullying may include but are not limited to:
C. “At school” means:
B. This Policy shall be:
E. Responsibility of Staff:
F. Responsibility of Students:
G. Prohibition against Retaliation:
H. False Reporting/Accusations:
I. Reports in Good Faith:
C. Police Notification:
D. Protection:
1. If a student is the victim of serious or persistent bullying:
B. The range of disciplinary actions that may be taken against a perpetrator for bullying, cyberbullying or retaliation shall include, but not be limited to:
| REPORT FORM (SAMPLE) |
| (Bullying and/or Cyberbullying) |
| Name: ______________________________Student ID: _______________________ Grade: ______ |
| Date: ______________ Time: _________ School: ___________________________________________ |
| Please answer the following questions about this reporting incident: |
| List the name of the alleged bully, and/or cyberbully. If name is not known, provide any other identifiable information: |
| Relationship between you and the alleged bully, and/or cyberbully: |
| Describe the incident: |
| When and where did it happen? |
| Were there any witnesses? [ ] yes [ ] no If yes, who? |
| Other information, including previous incidents or threats: |
| Student or parent declines to complete this form: Initial: _________________ Date: ____________ |
| I certify that all statements made in the complaint are true and complete. Any intentional false statement of fact will subject me to appropriate discipline. I authorize school officials to disclose the information I provide only as necessary in pursuing the investigation. |
| Signatures: |
| Student: ___________________________________________ Date: ____________ |
| School official receiving complaint: ______________________ Date: ____________ |
| School official conducting follow-up: _____________________ Date: ____________ |
| This document shall remain confidential |