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Bullying or Harassment Reporting Forms

The Office of Prevention Programs and Alternative Education has developed a bullying complaint form for individuals to report bullying incidents. An individual can complete a form giving the name of the person reporting the incident or the incident can be reported anonymously.

If you have information regarding a bullying or harassment act as defined in Lake County School Board Policy 5.33 and Florida Statute 1006.147, please fill out one of the two forms below to the best of your knowledge and submit to your school. To review Board Policy 5.33, go to the page for Bullying or Harassment Law and Policy.

The following factors will determine if bullying or harassment for students and employees falls within the scope of the Lake County School District:

A. During any education program or activity conducted by the District; or
B. During any school-related or school-sponsored program or activity or on a District school bus or at a District school bus stop; or
C. Through the use of data or computer software that is accessed through a computer, computer system, or computer network of the District within the scope of the school district, meaning regardless of ownership, any computer, computer system, or computer network that is physically located on school property or at a school-related or school-sponsored program or activity; or
D. Through the use of data or computer software that is accessed at a non-school-related location, activity, function, or program or through the use of technology or an electronic device that is not owned, leased, or used by the District or school, if the bullying substantially interferes with or limits the victim’s ability to participate in or benefit from the services, activities, or opportunities offered by the District or school or substantially disrupts the education process or orderly operation of a school. This paragraph does not require a school to staff or monitor any non-school-related activity, function, or program.

 

If you fear a student is in immediate danger, please contact the student's school or police immediately! 

Directions for Use of Forms:

  1. Click on the form of choice below.

  2. Print the form.

  3. Fill in the form.

  4. Drop the form off at the designated location in your school.

Bullying or Harassment Reporting Form

Bullying or Harassment Anonymous Reporting Form