Report Harassment, Intimidation, and Bullying

Ensuring Student Welfare and Safety

St. Anthony School adheres to the Archdiocese of Seattle Catholic Schools Policies to ensure students' welfare and safety. The policy defines the behaviors that qualify as harassment, intimidation or bullying (HIB), it dictates:

“Harassment, intimidation or bullying” means (1) any intentionally written message or image – including those that are electronically transmitted – (2) verbal, or physical act, including but not limited to one shown to be motivated by race, color, religion, ancestry, national origin, gender, sexual orientation, mental or physical disability, or other distinguishing characteristics, when the message, image, or act:

A. Physically harms a student or damages the student’s property;

B. Has the effect of substantially interfering with a student’s education;

C. Is so severe, persistent or pervasive that it creates an intimidating or threatening educational environment; or

D. Has the effect of substantially disrupting the orderly operation of the school."

According to Washington State law, actions which are intentional, repeated, negative, show a lack of empathy, and a power imbalance is considered bullying.

If you know of any incidents that fall under the abovementioned definitions, kindly complete the form below. Since we take reports on HIB seriously, most fields marked with an asterisk* are required. We appreciate your cooperation.

Thank you for helping us keep our school a safe place for all students!

Contact Information:

First Name*

Answer Required

Last Name*

Answer Required

Please provide the best Email address that we can use to contact you. *

Answer Required

Please provide the best phone number that we can use to contact you.*

Answer Required

About the incident:

Full name of the student who was bullied, harassed, or intimidated*

If you do not know the full name, kindly provide the grade level and class or teacher of the student (e.g. "Julius, 5A", "Julius, Mr. Pre").

Answer Required

Name(s) of the student(s) who bullied, harassed, or intimidated the person mentioned above*

If you do not know the name(s), please provide any descriptive information (gender, hair or eye color, grade level, teacher, complexion, etc.).

Answer Required

Was this the first time this incident happened?*

If you answered "No", it means that the negative behavior(s) happened multiple times.

Answer Required

Yes

As far as you can remember, please tell us the dates and times or what time of day (e.g. recess, AM or PM BASS, lunch) the incident(s) happened.*

Answer Required

Where did the incident happen?*

Answer Required

What happened during the incident?*

Answer Required

Incident description:

Answer Required

Was anybody physically hurt?*

Answer Required

Yes (medical attention NOT required)

Yes (medical attention required, please explain in "Other details" section)

Was the student bullied, harassed, or intimidated absent from school because of the incident?*

Answer Required

Yes (Please include the number of days in the "Other details" section)

Were there any witnesses?*

Answer Required

Yes (Please provide names below)

Name(s) of the witness(es)

Answer Required

Have you reported this incident to any school staff before?*

Answer Required

Yes (Please provide names below)

Name(s) of staff member(s)

Answer Required

Please provide any "other details" that will help us understand what happened.

Answer Required

What makes you believe that this incident rises to the level of HIB and not some sort of rude or unkind behavior?*

Answer Required

Today's date*

Answer Required

Please fix the highlighted areas below before submitting.

Report Harassment, Intimidation, and Bullying