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North Judson
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Elementary Bully Report Form
05/21/2022
Elementary Bully Reporting Form
This form may be used by anyone who experiences or witnesses bullying of a North Judson-San Pierre Elementary School student. Fill the form out fully and hit the SUBMIT button to turn it into the elementary school principal.
Date
(*)
Please select a date.
Your Name
Invalid Input
Did you witness the bullying?
(*)
Yes
No
Please specify yes or no.
I am a
(*)
Student
Staff Member
Parent/Guardian
Person being bullied
Community Member
Friend
Please choose one or more of the following.
Name of person being bullied
(*)
Please enter the name of the person being bullied.
Enter name of bully and their grade/school (if known). If there was more than one bully, add their names here too.
Invalid Input
Where did this take place?
Classroom (see below)
Lunchroom
Restroom
In the hallway
At recess time
Online/email/text
Bus stop
On the bus
Going to/from school
Invalid Input
If you selected classroom, please identify which room.
Invalid Input
Type of Bullying
(Select all that apply)
(*)
Physical Aggression
Excluding or rejecting
Social Media
Making the Victim of Jokes
Related to perceived sexual orientation
Threatening
Spreading Rumors
Text Messaging
Related to Disability
Teasing/Name Calling
Inappropriate Gestures
Written Communication
Related to Race
Please select the type of bullying.
Description of events
(Please be specific - use exact wording, names, dates, location and time, etc.):
(*)
Please describe the event.
Why did the bullying happen?
(*)
Please describe the event.
What has been done to help stop the bullying?
(*)
Told the person to stop
Moved away from the person
Ignored the situation or did nothing
Tried to make a joke of it; laughed it off
Tried to talk to the person
Told an Adult
Please choose one or more of the following.
Please list other students/staff who may have witnessed the bullying incident described above:
Invalid Input
Please use this space to tell us anything else about the bullying.
Invalid Input
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.
Human Verification
Invalid Input
Central Office
North Judson-San Pierre School Corporation
Dr. Annette Zupin
, Superintendent
801 Campbell Dr.
North Judson, IN 46366
Voice: 574-896-2155
Fax: 574-896-2156
Jr./Sr. High School
North Judson-San Pierre Jr./Sr. High School
1 Bluejay Dr.
North Judson, IN 46366
Voice: 574-896-2158
Fax: 574-896-2060
Brian Orkis
, Principal
Elementary
North Judson-San Pierre Elementary School
809 West Talmer Ave.
North Judson, IN 46366
Voice: 574-896-2128
Fax: 574-896-2129
Dr. Peter Morikis
, Principal
Purpose
Preparing Today's Youth for Tomorrow's Opportunities
Vision
Building a foundation and fostering opportunities for growth, so students can graduate, college and career ready.
Direction
Teaching students to be responsible, respectful, caring achievers through the Bluejay Way.
Connect With Us
Follow NJ-SP on Twitter
Follow NJ-SP on Instagram
Follow NJ-SP Elementary on FB
Bullying Policy
Bullying Policy
Elementary Bullying Form
Jr.-Sr. HS Bullying Form
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Services
Food Services
Free & Reduced Instructions & App
Meal Information
My School Bucks
My School Bucks Information
No Charge Policy
Non-Discrimination Statement
Health Services
Immunization Requirements
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Technology
Student AUP
Overview
Technology Plan
Title I Program
Seclusion & Restraint
Indiana Dept. of Ed. News
Standards
Jobs
Current Openings
Application Forms
Certified Background Check
Non-Cerified Background Check
Athletics
Athletic Web Site
Ticket Prices
Athletic Forms
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Athletic Awards
Sectional Alignments
Athletic Agreement
Contact
Corporation Office Personnel
Corporation Directors/Managers