Bullying Report Form
The Homer Central School District is committed to providing a safe and productive learning environment within its schools. Bullying against any individuals is strictly prohibited on school property, in school buildings, on school buses, and at school sponsored events and/or activities whether they occur on or off campus or online.

The term "bullying" is defined as a variety of negative acts--verbal, physical or psychological--carried out repeatedly over time. It involves a real or perceived imbalance of power, with a more powerful person or group attacking those who are less powerful.

All complaints are taken seriously and acted upon. If you would like to be contacted please include your information below. The accused student or staff member will not be shown this report. Due to privacy laws, you likely will not be notified of the outcome of the school district's investigation.

For issues other than bullying, please contact the appropriate school principal or district official. The main number for the school district is (607) 749-7241.

Please fill out this electronic form (or alternately, fill out this Dignity for all Complaint Form) to report any incidents or concerns regarding bullying or harassment. This form can be automatically submitted to the Homer Central School District by clicking on the "Submit Form" button at the bottom of the page.
Bolded questions must be answered to submit the form.

1. Your name (optional)

2. Your email or phone number (optional)

3. Date of complaint

4. Date of incident(s)

5. Time of incident(s)
Before school
During school
After school

6. Place of incident(s)
Bus (Please provide bus number in comment box)
Cafeteria
Hallways
At locker
Playground
In class (please provide class name in comment box)
Street name
By phone (calls or texts)
Internet

Other:

7. Describe the incident(s)

8. What is the sex of the student being bullied?
Male
Female

9. Do you know the name of the person being bullied?
Yes
No

Please provide name if known

10. What is the sex of the student doing the bullying?
Male
Female

11. Do you know the name of the person doing the bullying or harassment?
Yes
No

Please provide name(s) if known

12. Please provide the names of any witnesses (or enter "none").

13. What school does the person being bullied attend?
Homer Elementary
Homer Intermediate School
Junior High School
High School
Not sure

Thank you for helping us to create a school climate where all students feel safe and secure.


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Homer Central School District
Ms. Nancy Ruscio, Superintendent

80 South West Road
Homer, NY 13077
607-749-7241

© 2014 Homer Central School