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Bully Incident Reporting Form

Indiana's Bullying Legislation: IC 20-33-8-0.2 "Bullying" Sec. 0.2 As used in this chapter, "bullying" means overt, repeated acts or gestures, including (1) verbal or written communications transmitted; (2) physical acts committed; or (3) any other behaviors committed; by a student or group of students against another student with the intent to harass, ridicule, humiliate, intimidate, or harm the other student.

Bullying Incident Report Form
Please complete the bullying incident report. This report is anonymous. If you have an immediate concern, please contact the school's administration.

(*) Required


Please select all that apply(*)




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Type the name of the student(s) that are bullying and the school they attend.(*)

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Where did the bullying take place?


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Name of the student being bullied(*)

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Which school does this student attend?


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Description of Events (Please be specific - use exact wording, names, place, time, etc..)(*)

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When did this happen?(*)

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The administrators will investigate the report and take appropriate actions to deal with the situation. Since much of what we do needs to remain confidential, you may not know of the steps we take to stop the bullying. If the bullying does not stop, we need to take additional steps. Please let us know if the bullying continues.


(*)

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    • Corporation Office

      Pioneer Regional School Corporation
      413 S. Chicago St.
      Royal Center, IN 46978

      Mr. Charles Grable, Supt.
      Phone: 574-643-2605
      Fax: 574-643-9977

      Jr./Sr. High School

      Pioneer Jr./Sr. High School
      417 S. Chicago St.
      Royal Center, IN 46978

      Mr. Jeremy Tucker, Principal
      Phone: 574-643-3145
      Fax: 574-643-2020
    • Elementary School

      Pioneer Elementary School
      109 E. Black Lane
      Royal Center, IN 46978

      Dr. Beth Dean, Principal
      Phone: 574-643-2255
      Fax: 574-643-4029
  • Location