Negative Peer Interaction Form

This is a confidentail form used to report peer interactions. Please see student handbook for more information on followup process with this form. Required fields marked with an asterisk *

Which of the following are you reporting?*

Answer required for "Which of the following are you reporting?"

Negative Peer Interactions

Bullying (If you select this, please stop here and complete Bullying/Harassment Reporting Form instead)

Harassment (If you select this, please stop here and complete Bullying/Harassment Reporting Form instead)

Which of the following behaviors are being noted?*

Answer required for "Which of the following behaviors are being noted?"

virtuous behavior

teasing

name calling

intimidation

making fun of others

pushing/hitting/biting/stepping on feet

exclusion/talking down to

How often do you believe the behavior is happening?*

Answer required for "How often do you believe the behavior is happening?"

Only Once

once per hour

once per day

once per week

once per month

Does this behavior always involve the same students?*

Answer required for "Does this behavior always involve the same students?"

Yes

Not sure

Which of the following apply?*

Answer required for "Which of the following apply?"

I saw it happen.

My child told me about it.

Another student told me it happened.

I overheard students talking about it.

Another parent told me it happened.

Briefly describe what happened.*

Answer required for "Briefly describe what happened."

Please include the name(s) of the student(s) involved.*

Answer required for "Please include the name(s) of the student(s) involved."

Please include your name, phone number, and email address here.*

Answer required for "Please include your name, phone number, and email address here."

Please fix the highlighted areas below before submitting.

Negative Peer Interaction Form