The Chambersburg Area School District takes any suspected incidents of bullying, harassment, or school violence very seriously. Recognizing that

  • Bullying/harassment is a deliberate and hurtful behavior;
  • This behavior is often repeated over time;
  • It can be difficult for the student who is bullied/harassed to stand up for themselves;
  • There is an imbalance of power between the bully/harasser and student being bullied/harassed.

It is always recommended to students that they talk to their parent/guardian or a school saff member regarding any incident of harassment or violence at school.

This form is to be used to electronically report any incidents of suspected bullying/harassment and school violence. All information that is submitted on this form will be forwarded to the Director of Security, School Principal, and School Counselor of the school. Complete and specific details of any incident are needed, so that a thorough investigation can be conducted and school staff can implement appropriate interventions.

Please remember, it is unlawful to make accusations that are untrue; any such submissions may be passed along to authorities for investigation.



Items denoted with a red asterisk * are required.
CASD Electronic Suspected Bullying/Harassment/School Violence Reporting Form
 * Who is reporting?
 





 * School where incident occurred?
 
Incident Information
 * Name and Grade of Student Bullied/Harassed
 
 * Date and Time of Incident
 
 * Specific Location of Incident
 
 * Were there any witnesses? If yes, whom?
 
 * Was anyone else told of incident? If yes, whom?
 
 * Specific Details of Incident
 
 * In your own opinion, please rate the severity of the incident, with 1 being least severe and 10 being most severe.
 
 * Full Name
 
First Name
M.
Last Name
 * Phone Number
 
 -  - 
(XXX)-XXX-XXXX
 * Email Address