Get Help If this is an emergency call 911 This system does not provide emergency services. This system is only used to notify school administration. You may also go directly to any school official (teacher, counselor, principal, etc.) to get help. INSTRUCTIONS Please fill in all the information you can to help us stop the bully! Please try to give us a name or nickname. Don't worry about the spelling. Spell it like it sounds. Do the best you can to remember the date and time. Be sure to identify the school you are from so we can direct your information effectively. You must answer all questions with a yellow background before you will be able to submit this report. Corpus Christi Independent School District (CCISD) is committed to providing a safe, comfortable learning environment for all students. In addition to this system, incidents of bullying may be reported directly to a staff member at your school. What Happened

When did this occur? Date: Time: --Time-- 12:00AM 12:15AM 12:30AM 12:45AM 1:00AM 1:15AM 1:30AM 1:45AM 2:00AM 2:15AM 2:30AM 2:45AM 3:00AM 3:15AM 3:30AM 3:45AM 4:00AM 4:15AM 4:30AM 4:45AM 5:00AM 5:15AM 5:30AM 5:45AM 6:00AM 6:15AM 6:30AM 6:45AM 7:00AM 7:15AM 7:30AM 7:45AM 8:00AM 8:15AM 8:30AM 8:45AM 9:00AM 9:15AM 9:30AM 9:45AM 10:00AM 10:15AM 10:30AM 10:45AM 11:00AM 11:15AM 11:30AM 11:45AM 12:00PM 12:15PM 12:30PM 12:45PM 1:00PM 1:15PM 1:30PM 1:45PM 2:00PM 2:15PM 2:30PM 2:45PM 3:00PM 3:15PM 3:30PM 3:45PM 4:00PM 4:15PM 4:30PM 4:45PM 5:00PM 5:15PM 5:30PM 5:45PM 6:00PM 6:15PM 6:30PM 6:45PM 7:00PM 7:15PM 7:30PM 7:45PM 8:00PM 8:15PM 8:30PM 8:45PM 9:00PM 9:15PM 9:30PM 9:45PM 10:00PM 10:15PM 10:30PM 10:45PM 11:00PM 11:15PM 11:30PM 11:45PM Where did the incident occur? -- Select One -- Off Campus ADKINS MS ALLEN ES BAKER MS BARNES ES BERLANGA ES BRANCH CAREER TECH HS BROWNE MS CALK-WILSON ES CARROLL HS CLUB ESTATES ES COLES COLLEGIATE HS CROCKETT ES CULLEN MS CUNNINGHAM MS AT SOUTH PARK DAWSON ES DRISCOLL MS ECDC EVANS ES FANNIN ES GALVAN ES GARCIA ES GIBSON ES GLORIA HICKS ES GRANT MS HAAS MS HAMLIN MS HOUSTON ES JONES ES KAFFIE MS KING HS KOLDA ES KOSTORYZ ES LOS ENCINOS ES MARTIN MS MARY GRETT MEADOWBROOK ES MENGER ES METRO E (WYNN SEALE) MILLER METRO MIRELES ES MONTCLAIR ES MOODY HS MOORE ES OAK PARK SES RAY HS SANDERS ES SCHANEN ESTATES ES SHAW SES SMITH ES STUDENT SUPPORT CENTER TRAVIS ES VETERANS MEMORIAL HS WEBB ES WINDSOR PARK ES WOODLAWN ES YEAGER ES ZAVALA ES Please describe the events (Be specific and include as many details as possible about the event. For example, when describing the location, was it a physical location or was the victim bullied via social media, email, text, etc.). Remaining characters: Your Information (optional)

First Name Last Name Role -- Select One -- Bully Victim Witness School Official Family Friend Email Address Phone Campus -- Select One -- Off Campus ADKINS MS ALLEN ES BAKER MS BARNES ES BERLANGA ES BRANCH CAREER TECH HS BROWNE MS CALK-WILSON ES CARROLL HS CLUB ESTATES ES COLES COLLEGIATE HS CROCKETT ES CULLEN MS CUNNINGHAM MS AT SOUTH PARK DAWSON ES DRISCOLL MS ECDC EVANS ES FANNIN ES GALVAN ES GARCIA ES GIBSON ES GLORIA HICKS ES GRANT MS HAAS MS HAMLIN MS HOUSTON ES JONES ES KAFFIE MS KING HS KOLDA ES KOSTORYZ ES LOS ENCINOS ES MARTIN MS MARY GRETT MEADOWBROOK ES MENGER ES METRO E (WYNN SEALE) MILLER METRO MIRELES ES MONTCLAIR ES MOODY HS MOORE ES OAK PARK SES RAY HS SANDERS ES SCHANEN ESTATES ES SHAW SES SMITH ES STUDENT SUPPORT CENTER TRAVIS ES VETERANS MEMORIAL HS WEBB ES WINDSOR PARK ES WOODLAWN ES YEAGER ES ZAVALA ES Grade -- Select One -- Not Applicable PK KG 01 02 03 04 05 06 07 08 09 10 11 12

Information about who was there, what role they played, and/or who you talked to about the incident In this section you will be describing the people that were there when the bullying incident occurred.



Please identify the alleged victim or victims of the incident.

Please identify the alleged bully or bullies involved in the incident.

You will need to provide information about at least one bully and one victim in order to submit your report.



If you talked to a school official (teacher, counselor, principal, etc.) about the incident,

you will enter the information in this section also. Click the "Ok" button to begin NOTICE The District prohibits bullying on school property, at school-sponsored or school-related activities, or in any vehicle operated by the District. Bullying may include verbal or written expression, expression through electronic means, or physical conduct. Bullying is not tolerated by the District, and any student or parent of a student who believes that the student or another student has experienced bullying or that a student has engaged in bullying is encouraged to immediately report the incident. Retaliation against anyone involved in the reporting process is a violation of District policy and is prohibited. Students or parents may report an alleged incident of bullying, orally or in writing, to a teacher, school counselor, principal or other District employee. Students or parents may contact the District to obtain an incident report form that may be used to submit the report. Please note that after submission of the complaint to the District employee, the District may assign the report to a campus administrator to follow up on the submitted report and any other important matters pertaining to the report. We encourage you to communicate with your designated campus administrator during this time. CCISD policy FFI: student Welfare: Freedom from Bullying