Report Bullying - Bellamy

The Rome City School District and the Board of Education take bullying very seriously. We are committed to providing a positive school environment for all of our 5,500 students in Pre-K through 12th grade. By developing a bullying report through this system you are asking our School District Superintendent and Administration to begin an investigation within one full business day. You may use this online system to report bullying of any kind that may impact a student’s school day or the school environment. It is important to know that the more details you can provide in your report the more effective we can be with our investigation.

Report Bullying - Bellamy
SchoolThis is a Bellamy report - all information will be send to the Bellamy administration & Superintendent's office.
Today's Date
Name of person reporting incident
Role of person reporting incident
Phone
Email
Name of the target (student being bullied, harassed, or discriminated against):
Name(s) of alleged offender(s)
Date(s) of Incident(s)
Time(s) of Incident(s)
What was your involvement in the incident?
Where did the incident happen? (check all that apply) 
 School Function
 Bathroom
 Cafeteria
 Classroom
 

Electronic Communications

 Gym
 Hallway
 Locker
 Off School Property
 On a school bus
 On school property
 Somewhere Else
Type of Incident(s) (Check all that apply) 
 Physical contact (kicking, punching, spitting, tripping,pushing,taking belongings)
 Verbal threats (gossip, name-calling, put-downs, teasing, being mean, taunting, making threats)
 Psychological (non-verbal actions, spreading rumors, social exclusion, intimiation
 Abuse (actions or statements that put an individual in fear of bodily harm)
 Cyberbullying (misusing technology/social media to harass, tease, threaten, post pictures (sexting)
 
Describe the specific nature of the incident. What happened? (Be as specific as possible).  What did the alleged offender say or do? Include any copies of text messages, emails, etc. if possible.  Who was present and involved? Include names if possible.
Type of bias involved (if known): (Check all that apply) 
 Race
 Color
 Weight/Size
 National Origin
 Ethnic Group
 Religion
 Sex
 Religious Practices
 Disability
 Sexual orientation
 Gender
 
“I acknowledge that all of the information included in this form is accurate. This submission is a request for the Superintendent and Administration of the Rome City School District to begin an investigation of bullying, harassment and/or cyber-bullying. An investigation will begin within ONE business day.” 
 I Agree

 



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