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Bully Reporting Form

Ensuring the safety of our students and schools is always a top priority for us at Burbank Schoool District. It is only in working together that we can continue to make this the positive learning environment that our students can all thrive.

The Bullying, Harassment or Intimidation Reporting Form should be used to report alleged incidents of bullying, harassment, or intimidation that occurred during the current school year on school property, at a school-sponsored activity or event off school property, on a school bus, on the way to and/or from school, or through electronic communication on or off school property. 

The online reporting system are for Students, families, and community members to report concerns which may affect the peace of mind of students or endanger the safety of people or school facilities. Such concerns may include, but are not limited to, bullying, abuse, bomb threats, cyber crimes, discrimination, drugs, health concerns, suspicious behavior, vandalism, fighting, & weapons.

Directions:

  • Please complete the form below to the best of your ability. 
  • All questions with an * asterik must be answered before the submission in order to be able to address the problem.
  • You can report this incident anonymously, or provide us your contact information. This information might be helpful in our investigation of this incident and help maintain school environments that are safe and conducive for learning.
  • You may contact the school for additional information or assistance at any time.

Definitions:

Bullying – is unwanted, demeaning behavior among students that involves a real or perceived power imbalance. The behavior is repeated, or is highly likely to be repeated, over time. In order to be considered bullying, the behavior must be intentional and include: 1) An imbalance of power (students who bully use their physical, emotional, social, or academic power to control, exclude, or harm others), and 2) Repetition (bullying behaviors happen more than once or are highly likely to be repeated based on evidence gathered).

Cyberbullying – is bullying that takes place over digital devices like cell phones, computers, and tablets. Cyberbullying can occur through texting, apps, or online via social media, forums, or gaming where people can view, participate in, or share content. Cyberbullying includes sending, posting, or sharing negative, harmful, false, or hurtful content about another student. It can include sharing personal or private information about someone else causing embarrassment or humiliation.

Harassment – includes actual or perceived negative actions that offend, ridicule, or demean another student with regard to race, ethnicity, national origin, immigration status, family/parental or marital status, sex, sexual orientation, gender identity, gender expression, religion, ancestry, physical attributes, socioeconomic status, physical or mental ability, or disability.

Intimidation – is any communication or action directed against another student that threatens or induces a sense of fear and/or inferiority. Retaliation may be considered a form of intimidation.

Person Reporting the Incident

Who is submitting this form?*
Please tell us who you are
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Are you the:*
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Incident Information

Victim Information

School:
What school does the victim attend? (if known)
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Grade
What grade is the student(s) at school? (If known)
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Offender Information

School:
What school does the offender attend? (if known)
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Grade
What grade is the student(s) at the school? (if known)
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Details of Incident

Where did the incident occur?*
Check all that apply
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What statement best describes what happened?*
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Disclaimer*
By submitting this form you acknowledge that the information entered is complete, true, and accurate. Please note that whoever engages in any conduct with intent to convey false or misleading information under circumstances where such information may reasonably be relied upon and where such information indicates that an activity has taken, is taking, or will take place would constitute a violation of law and the submitter of such information may be prosecuted.
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