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Grand Prairie Bullying Referral Form

Bullying is defined as a situation in which a student is exposed repeatedly and over time to negative actions on the part of one or more students. Negative actions can include inappropriate gestures, written statements, verbal remarks, or physical acts of aggression that place the student in reasonable fear of harm to his person or property, or that has the effect of insulting or demeaning any student in such a way as to interfere with their education.

To report a bullying situation as described above, please complete the "Bullying Referral Form" below and submit. Grand Prairie Elementary School appreciates your communication and support in ensuring the safety and welfare of all students.

Your Name *
Bully's Name *
Phone *
Email
Are you a: *
Please provide your homeroom teacher *
Please indicate the grade(s) of the students involved

When did the incident occur

Today
Yesterday
One week ago
More than a week ago
Please provide a specific date if known

Where did the incident occur

Bus
Bus Stop
Classroom
Hallway
Cafeteria
Gym
Other

Please describe the incident and location if other


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