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

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

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

Only Once

once per hour

once per day

once per week

once per month

Does this behavior always involve the same students?*

Answer Required

Yes

Not sure

Which of the following apply?*

Answer Required

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

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

Answer Required

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

Answer Required

Please fix the highlighted areas below before submitting.

Negative Peer Interaction Form