Get in Touch
3434 North Monroe St.
Tallahassee, FL 32303
(850) 681-7827
(850) 325-6706
info@tsmas.org
schoolofmathandscience.org
Resources
CLEVER
FORTIFYFL
SCHOOL PAY
DONATE
TSMS CONNECT
CONTACT US
(850) 681-7827
Select Language
English
Arabic
Portuguese
Russian
Spanish
Turkish
Search...
Menu
Home
About
About TSMS
Orientation 2022
TSMS Board
Donate
Employment
TSMS Campus
School Calendar
Search
Privacy Policy
USDA Nondiscrimination Statement
Admission
Enrollment Overview
Apply Online
Academics
Math Stars
Math Stars Registration
Student Handbook
Read-at-Home Plan
Summer Assignments
Supply Lists
TSMS Academic Performance
Out of Field Teachers for ESOL
STEM Education
Curriculum
Academic Teams
Robotics
Online Resources
Reading
School Hours & Bell Schedule
Testing, Research & Evaluation
SERVICES
Transportation Policy
Bus Routes
Food Service
Wellness Policy
Uniform Policy
Extended Day Program
School Life
Weekly Newsletters
TSMS Excuse Absence Form
Bullying / Harassment Reporting Form
School Forms
Parent and Family Engagement Plan
TSMS Uniform Swap
Clubs & Tutoring
TSMS Alumni Form
Home Visits
Home Visit Request Form
TSMS Volunteer Application Form
Report Suspicious Activity
Grievance Reporting Flow Chart
News
TSMS in the News
TSMS PVO
Bullying / Harassment Reporting Form
You are here:
Home
/
School Life
/
Bullying / Harassment Reporting Form
This form should be used to report a possible incident of bullying as defined in TSMS's policy prohibiting bullying and harassment. Bullying according to school policy involves systematic and chronic inflictions of physical hurt or psychological distress on one or more student or employee. Harassment according to school policy is threatening, insulting, or dehumanizing gestures, use of data, telecommunications facilities (wireless phones, text messages), or computer software or technology (email, social networking sites, blogs, web pages), or written, verbal, or physical conduct directed against a student or employee. This form can be filled out by any person concerned about bullying or harassment. (Please use the final 2 questions at the bottom of this form if you would like to list your needs, your concerns.)
Your Name: (optional)
Invalid Input
Name of person being mistreated:
(*)
Invalid Input
Name of person accused of bullying/harassment:
(*)
Invalid Input
Date of incident
(*)
Invalid Input
Additional dates of incidents?
Invalid Input
Where did the incident happen?
(*)
Invalid Input
Choose the statement(s) that best describes what happened. Choose all that apply.
(*)
Taunting and Insults
Threats
Stalking
Theft
Cyber Bullying
Access Denied
Social Isolation / Exclusion
Verbal Intimidation
Physical Intimidation
Physical Violence
Public Humiliation
Rumor-Spreading
Name Calling
Mean Comments
Gestures
Other
Invalid Input
Other:
Invalid Input
What did the alleged offender(s) say or do?(*)
(*)
Invalid Input
Was the incident related to the alleged victimized person's race, sex, or disability?
(*)
Yes
No
Invalid Input
If yes, please give a brief explanation.
Invalid Input
Have you reported this incident to anyone before?
(*)
Yes
No
Invalid Input
If yes, who?
Invalid Input
Please list any witnesses.
Invalid Input
Thank you. This report will be followed up in a prompt manner. By completing this form, you are verifying that your statements are true and exact to the best of your knowledge. If you fear a person is in IMMEDIATE danger, please contact a trusted individual right away!
If you have concerns, please list them.
Invalid Input
If you have needs, please list them.
Invalid Input
Submit
Copyright © 2017. TSMS - All rights reserved.
Terms of Use and Privacy Policy
Scroll