CCS STUDENT BULLYING/HARASSMENT FORM

This system is not monitored during the summer break.
This bullying report system is only monitored during school hours while school is in session.

The Say Something Anonymous Reporting System is monitored 24/7 all year for reporting bullying/harassment or other safety concerns. https://www.saysomething.net/
The link is located on the CCS website and all school webpages, or download the SS-ARS app to your smartphone.

This report is not intended for emergency use. If you have an emergency please call 911 or contact law enforcement.

Thank you

 
What is Bullying?
Bullying includes specific characteristics and criteria defined in NC Bullying Law § 115C 407.15
4 Key Characteristics of Bullying
  • Repetition
  • Intentional
  • Unprovoked
  • Imbalance of Power
DOES THE INCIDENT MEET NC BULLYING CRITERIA?
A pattern (repeated) of ONE or more of the following:
1. Gestures
2. Communications (verbal/written) includes online communications/social media, etc.)
3. Physical Act
4. Threatening Communication
AND
One or more of the following:
1. Damage to Property
2. Places student in actual and reasonable fear of harm to her or her person
3. Creates or is certain to create a hostile environment by substantially interfering with or impairing student's educational performance, opportunities or benefits
(Hostile environment meets both criteria below)
a. Student subjectively views the conduct as bullying or harassing behavior
b. Behavior is objectively severe or pervasive enough that a reasonable person would agree it is bullying or harassing behavior
MOTIVATED by characteristics such as:
Race | Ancestry | Religion | Physical Appearance | Color | National origin | Academic status | Sexual orientation | Gender identity | Socioeconomic status | Mental, physical, developmental, or sensory disability
 
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Email *
Date Started *
MM
/
DD
/
YYYY
Is this an anonymous report? ¿Es este un reporte anónimo? *
First and Last name of person completing this form. Nombre y apellido de la persona que está completando este formulario.
What is the best way to contact you for more information? ¿Cuál es la mejor manera de contactarlo para obtener más información?
i.e. phone # or email
 *
Name of Student you believe is being bullied or harassed. Nombre del estudiante que usted cree está siendo Intimidado (bullied) o acosado
First and Last name if known.
 *
School Escuela* *
What are you reporting? ¿Qué está informando? *
Date(s) of incident(s) Fecha(s) del incidente(s) mm/dd/yyyy *
MM
/
DD
/
YYYY
About how many times has this occurred? ¿Aproximadamente cuántas veces ha ocurrido esto?
 *
Name(s) of individual(s) you are reporting as bullying or harassing Nombre(s) de la(s) persona(s) que está reportando por ocasionar Intimidacion (Bullying) o acoso.*
 *
Names of observers or bystanders. Nombre de los observadores o espectadores.
 *
Have you told anyone at school about this incident? ¿Le ha informado a alguien en la escuela sobre este incidente?
 *
If yes, who did you tell and when did you tell them? En caso afirmativo, ¿a quién se lo dijo y cuándo se lo dijo?
 *
Describe what happened and where it occurred. Describa lo que sucedió y dónde ocurrió.
 *
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