Family Resources
New Leadership Charter School & District
  Anti-Bullying Plan
                                   2010

New Leadership Charter School (NLCS) will not tolerate any unlawful or disruptive behavior, including any form of bullying, cyber-bullying, or retaliation, in our school buildings, on school grounds, or in school-related activities. We will investigate promptly all reports and complaints of bullying, cyber-bullying, and retaliation, and take prompt action to end that behavior and restore the target’s sense of safety. We will support this commitment in all aspects of our school community, including curricula, instructional programs, staff development, extracurricular activities, and parent or guardian involvement.

I.Leadership

All members of the NLCS community are expected to maintain a safe learning environment The following key members of the administrative staff of NLCS have been identified and are committed to adhering to the requirements of NLCS’s bullying prevention plan:

•      All NLCS community members will report instances of bullying and retaliation to any staff member or administrator who in turn will  
      report these incidents to the Assistant Principal (AP) and/or Dean of Students (Dean)

•      The Chief Executive Officer (CEO) and Principal will ensure that all staff members exercise their obligation in the reporting of and 
       addressing incidents of bullying and retaliation.

•      The AP and the Dean are responsible for responding to and investigating all reported incidents of bullying and retaliation;   
       using the Incidence Reporting Form (IRF; see Appendix A) to develop a tracking system for incidents of bullying and retaliation as        well as developing a system to access information related to targets and aggressors; collecting and analyzing school wide data on        bullying for assessment and the development of preventive measures;working in conjunction with the CEO and Principal in  
      developing an internet safety plan as well as amending student and staff handbooks; collaborating with the Guidance Counselors           in developing strategies and protocols for responding to the targets and aggressors

•      The Coordinator of Equity and Leadership, in conjunction with the Principal, AP, Dean, Guidance Counselors, Coordinator of  
       Admissions and Retention, and Teaching staff, is responsible for the coordination of the research, development, and      
       implementation of developmentally appropriate and effective bullying prevention curricula; assisting the AP and/or Dean in 
       any aspect of the bullying prevention that they assign; planning for ongoing professional development; planning for family 
       engagement via workshops and informational materials; and periodically reviewing and updating the Plan (at least once a         
       year)

•      The Guidance Counselors are responsible for taking leadership in the selection of bullying prevention curricula


II. Prohibition of Bullying and Cyber-bullying

              Acts of bullying, which include cyber-bullying, are prohibited:

1.    on school grounds and property immediately adjacent to school grounds, at a school-sponsored or school-related
activity, function, or program whether on or off school grounds, at a school bus stop, on a school bus or other vehicle
owned, leased, or used by a school district or school; or through the use of technology or an electronic device owned,
leased, or used by a school district or school, and

2.    at a location, activity, function, or program that is not school-related through the use of technology or an electronic
device that is not owned, leased, or used by a school district or school, if the acts create a hostile environment at     
                             school for the target or witnesses, infringe on their rights at school, or materially and substantially disrupt the 
                             education process or the orderly operation of a school. 


III.Definitions

              Aggressor is a student who engages in bullying, cyberbullying, or retaliation.

              Bullying, as defined in M.G.L. c. 71, § 37O, is the repeated use by one or more students of a written, verbal, or electronic
              expression or a physical act or gesture or any combination thereof, directed at a target that:

         i. causes physical or emotional harm to the target or damage to the target’s property;

         ii. places the target in reasonable fear of harm to himself or herself or of damage to his or her property;

          iii. creates a hostile environment at school for the target;

          iv. infringes on the rights of the target at school; or

          v. materially and substantially disrupts the educational process or the orderly operation of a school.

               Cyberbullying, is bullying through the use of technology or electronic devices such as telephones, cell phones, computers, and                 the Internet. It includes,but is not limited to, email, instant messages, text messages, and Internet postings. See M.G.L. c. 71, 
               § 37O for the legal definition of cyberbullying.

               Discrimination is treating people differently, or interfering with or preventing a person from enjoying the advantages,       
               privileges,or courses of study in a public school because of an individual’s actual or perceived race, color, national origin, 
               ethnicity, religion, gender, sexual orientation, age, or disability (i.e. protected status). A person may not be subjected to
               discipline or more severe punishment, nor denied the same rights as the other students, because of his/her membership in a 
               protected class.

               Hostile environment, as defined in M.G.L. c. 71, § 37O, is a situation in which bullying causes the school environment to be 
               permeated with intimidation, ridicule, or insult that is sufficiently severe or pervasive to alter the conditions of a student’s 
               education.

               Retaliation is any form of intimidation, reprisal, or harassment directed against a student who reports bullying, provides          
               information during an investigation of bullying, or witnesses or has reliable information about bullying.

               Staff includes, but is not limited to, educators, administrators, counselors, school nurses, cafeteria workers, custodians, bus 
               drivers, coaches, advisors to extracurricular activities, support staff, and paraprofessionals.

              Target is a student against whom bullying, cyberbullying, or retaliation has been perpetrated.


IV.     Reporting Bullying and Retaliation

        A.        Reporting Bullying or Retaliation

               In general, reports of bullying or retaliation may be made by staff, students, parents or guardians, or others, and may be oral 
               or written. Oral reports made by or to a staff member shall be recorded in writing using the IRF. An NLCS staff member is
               required to report immediately to the AP or Dean                  any instance of bullying or retaliation the staff member becomes aware of or witnesses. The reporting of bullying may result in a DNR for all parties                   involved Reports made by students, parents or guardians, or other individuals who are not school staff members, may be made anonymously to any                 NLCS staff member.  NLCS will provide all staff members with copies of the Incidence Reporting Form.  Copies of these forms will also be placed in                  the school’s main office, staff lounge, and the counselors’ office. 

             A downloadable version of the IRF will be available on the school’s website, which may be accessed by the entire school community and public.                      These forms, once filled, can be returned in person or with a student to the main office, the AP or the Dean.  They can also be mailed to the school                  at:New Leadership Charter School, 37 Alderman Street, Springfield, MA 01108.  All calls, anonymous or otherwise, can be made using the school’s                 number, 413-782-9111.  The main office staff will immediately report and/or forward these calls to the AP and/or Dean. 

         The IRF will be made available in both English and Spanish.

             At the beginning of each school year, NLCS will provide the school community, including administrators, staff, students, and parents or guardians,
             with written notice of its policies for reporting acts of bullying and retaliation. A description of the reporting procedures and resources, including the    
             name and contact information of AP and Dean, will be incorporated in student and staff handbooks, on the school’s website, and in information about                the Plan that is made available to parents or guardians.

        B.Reporting by Staff

             A staff member will report immediately to the AP or Dean when he/she witnesses or becomes aware of conduct that may be considered bullying or                  retaliation. The requirement to report to the AP or Dean does not limit the authority of the staff member to respond to behavioral or disciplinary                          incidents consistent with school or district policies and procedures for behavior management and discipline.

        C.  Reporting by Students, Parents or Guardians, and Others

             NLCS expects students, parents or guardians, and others who witness or become aware of an instance of bullying or retaliation involving a student to               report it to the AP, Dean, or any other staff member they are able to contact.  Reports may be made anonymously, but no disciplinary action will be                 taken against an alleged aggressor solely on the basis of an anonymous report. Students, parents or guardians, and others may request assistance f               from a staff member to complete a written report. Students will be provided practical, safe, private and age-appropriate ways to report and discuss an                incident of bullying with a staff member.

V.      Responding to a Report of Bullying or Retaliation

        A.  Obligations to Notify Others

        a.   Notice to parents or guardians
             Upon determining that bullying or retaliation has occurred, the AP or Dean will promptly notify the parents or guardians of the target and the        
             aggressor of  this, and of the procedures for responding to it. There may be circumstances in which contacts to parents or guardians may be made                  prior to any investigation. Notice will be consistent with state regulations at 603 CMR 49.00.

         b.  Notice to another school or district
              If the reported incident involves students from more than one school district, charter school, non-public school, approved private special education                    day or residential school, or collaborative school, the AP or Dean will promptly notify by telephone the principal or designee of the other school(s) of                  the incident so that each school may take appropriate action. All communications will be in accordance with state and federal privacy laws and                        regulations,and 603 CMR 49.00.

         c.  Notice to law enforcement
             At any point after receiving a report of bullying or retaliation, including after an investigation, if the AP or Dean has a reasonable basis to believe that                  criminal charges may be pursued against the aggressor, the AP and/or Dean will consult with the Principal and/or CEO and the Springfield Police                    Department may be notified. Notice will be consistent with the requirements of 603 CMR 49.00 and the police department. Also, if an incident occurs                on school grounds and involves a former student under the age of 21 who is no longer enrolled in school, the AP or Dean shall contact the Springfield                Police Department if he or she has a reasonable basis to believe that criminal charges may be pursued against the aggressor.

         B.  Investigation

            The AP or Dean will investigate promptly all reports of bullying or retaliation and, in doing so, will consider all available information known, including t  i               ihe nature of the allegation(s) and the ages of the students involved. The reporting of bullying may result in a DNR for all parties involved.

             During the investigation the AP or Dean will, among other things, interview students, staff, witnesses, parents or guardians, and others as necessary.               The AP or Dean will remind the alleged aggressor, target, and witnesses that retaliation is strictly prohibited and will result in disciplinary action.  The                AP or Dean will consult with the Guidance Counselors as appropriate.  To the extent practicable, the AP and/or Dean will maintain confidentiality                    during the investigative process.  The AP or Dean will use the Intervention Investigation Form (see Appendix B) as a written record of the                
             investigation.

             Procedures for investigating reports of bullying and retaliation will be consistent with school or district policies and procedures for investigations. If                     necessary, the AP or Dean will consult with legal counsel about the investigation.

          C.  Determinations

            The AP or Dean will make a determination based upon all of the facts and circumstances. If, after investigation, bullying or retaliation is substantiated,               the principal or designee will take steps reasonably calculated to prevent recurrence and to ensure that the target is not restricted in participating in                   school or in benefiting from school activities. The AP or Dean wil: 1) determine what remedial action is required, if any, and 2) determine what          
             responsive actions and/or disciplinary action is necessary.

             Depending upon the circumstances, the AP or Dean may choose to consult with the students’ teacher(s) and/or school counselor, and the target’s or               aggressor’s parents or guardians, to identify any underlying social or emotional issue(s) that may have contributed to the bullying behavior and to                     assess the level of need for additional social skills development.

             The AP or Dean will promptly notify the parents or guardians of the target and the aggressor about the results of the investigation and, if bullying or                   retaliation is found, what action is being taken to prevent further acts of bullying or retaliation. All notice to parents must comply with applicable state                and federal privacy laws and regulations. Because of the legal requirements regarding the confidentiality of student records, the AP or Dean cannot                   report specific information to the target’s parent or guardian about the disciplinary action taken unless it involves a “stay away” order or other directive               that the target must be aware of in order to report violations.

           D.  Consequences for Bullying or Retaliation

             If the AP or Dean decides that disciplinary action is appropriate, the disciplinary action will be determined on the basis of facts found, including the                   nature of the conduct, the age of the student(s) involved, the student(s)’s disability status*, and the need to balance accountability with the teaching                 of appropriate behavior. Discipline will be consistent with the Plan and with NLCS’s code of conduct.  As a general rule, however, disciplinary                           consequences against the aggressor are enumerated as follows:

  •       1st offense will include a DNR and suspension for 3 to 5 days
  •       2nd offense will include a DNR and suspension for 5 to 10 days. An automatic referral to the Springfield Police will be made.
  •       3rd last offense will include a 30 day suspension or possible expulsion.   An automatic referral to the Springfield Police will be made

              *Discipline procedures for students with disabilities are governed by the federal Individuals with Disabilities Education Act (IDEA), which should be                     read in cooperation with state laws regarding student discipline.

           E.  False Charges

             Any student who knowingly makes false charges regarding bullying or retaliation may be subjected to any of the disciplinary and/or corrective          
             action(s) detailed above in section V.D.


VI.  Bullying Prevention Strategies

            1.  Strategies for the aggressor

              Upon the AP or Dean determining that bullying or retaliation has occurred, the law requires that the NLCS use a range of responses that balance the                need for accountability with the need to teach appropriate behavior. M.G.L. c. 71, § 37O(d)(v). Skill-building approaches that the AP or Dean may                     consider in consultation with counselors, teaching staff, or other staff may include:

           •       offering individualized skill-building sessions based on NLCS’s bullying prevention curricula;

           •providing relevant educational activities for individual students or groups of students, in consultation with guidance counselors and other                                    appropriate school personnel;

           •implementing a range of academic and nonacademic positive behavioral supports to help students understand pro-social ways to achieve their                          goals;

           •meeting with parents and guardians to engage parental support and to reinforce the anti-bullying curricula and social skills building activities at                         home;

           •providing families with periodic after-school workshops on bullying and promoting pro-social behaviors at home

           •adopting behavioral plans to include a focus on developing specific social skills; and

           •making a referral for evaluation and/or counseling.


           2.Strategies for the target

             The AP or Dean will take steps to assess the need to restore a sense of safety to the alleged target and/or to protect the alleged target from possible                further incidents. Responses to promote safety may include, but not be limited to

           •creating a personal safety plan

           •pre-determining seating arrangements for the target and/or the aggressor in the classroom, at lunch, or on the bus

           •identifying a staff member who will act as a “safe person” for the target, and/or

           •altering the aggressor’s schedule and access to the target

           •increasing adult supervision during transition times and/or at the location where the bullying behavior occurred

           •Writing a “Stay Away” plan that would require that the aggressor not interact with the target in any manner until it is determined at some future                         date that it would be safe to remove the requirements set forth in the “Stay Away” plan.

             The AP or Dean will take additional steps to promote safety during the course of and after the investigation, as necessary.  The AP or Dean will                        implement appropriate strategies for protecting from bullying or retaliation a student who has reported bullying or retaliation, a student who has                         witnessed bullying or retaliation, a student who provides information during an investigation, or a student who has reliable information about a reported               act of bullying or retaliation.

             Within a reasonable period of time following the determination and the ordering of remedial and/or disciplinary action, the AP or Dean will contact the                target to determine whether there has been a recurrence of the prohibited conduct and whether additional supportive measures are needed. If so, the                 AP or Dean will work with appropriate school staff to implement them immediately.


VII. Training and Professional Development

             A. Annual staff training on the Plan

             NLCS will provide annual training for all school staff on the Plan, which will include staff duties, an overview of the steps that the AP or Dean will                        follow upon receipt of a report of bullying or retaliation, and an overview of the bullying prevention curricula to be offered at all grades throughout the                    school.  A staff member hired after the start of the school year will participate in school-based training during the school year in which he/she is                       hired, unless he/she can demonstrate participation in an acceptable and comparable program within the last two years.

             B. Ongoing professional development

             The goal of NLCS’s bullying prevention professional development is to establish a common understanding of tools necessary for staff to create a                       school climate that promotes safety, civil communication, and respect for differences.  Professional development will build the skills of staff members                to prevent, identify, and respond to bullying. As required by M.G.L. c. 71, § 37O, the content of school-wide and district-wide professional                                development will be informed by research and will include information on:

                 (i) developmentally (or age-) appropriate strategies to prevent bullying;

                 (ii) developmentally (or age-) appropriate strategies for immediate, effective interventions to stop bullying incidents;

                 (iii)information regarding the complex interaction and power differential that can take place between and among an aggressor, target, and                                     witnesses to the bullying;

                 (iv) research findings on bullying, including information about specific categories of students who have been shown to be particularly at risk for                               bullying in the school environment;

                 (v) information on the incidence and nature of cyberbullying; and (vi) Internet safety issues as they relate to cyberbullying.
        
             Professional development will also address ways to prevent and respond to bullying or retaliation for students with disabilities that must be                
             considered when developing students’ Individualized Education Programs (IEPs). This will include a particular focus on the needs of students with                    autism or students whose disability affects social skills development.

            Additional areas identified by NLCS for professional development include:

                   • promoting and modeling the use of respectful language;

                   • fostering an understanding of and respect for diversity and difference;

                   • building relationships and communicating with families;

                   • constructively managing classroom behaviors;

                   • using positive behavioral intervention strategies;

                   • applying constructive disciplinary practices;

                   • teaching students skills including positive communication, anger management, and empathy for others;

                   • engaging students in school or classroom planning and decision-making; and

                   • maintaining a safe and caring classroom for all students.


            Professional Development Activities for the 2010-2011 school year include:

                  • Bullying prevention training by Robin D’ Antona, E.d.D. (Two 3-hour Sessions in May 2010 and September 2010)

                  • Joe The Byker Staff Training (2 hour session in September 2010)

                  • Community Caring Staff Training (3-hour session in March 2010)

                  • Crisis, Bullying, and Suicide training (2 hour session in August 2010)

                  • Boys Town Behavioral Management Training (2 full days in August 2010)

                  • Periodic classroom support by in-house Boys Town consultants (ongoing)

             NLCS is currently researching state approved, research-based professional development opportunities for the 2011-2012 school year. 

           C.   Written notice to staff     '
       
           NLCS will provide all staff with an annual written notice of the Plan by publishing information about it, including sections related to staff duties, in the                 staff handbook.

VIII. Academic and Non-Academic Activities 

             A. Specific bullying prevention approaches

             Bullying prevention curricula will be informed by current research which, among other things, emphasizes the following approaches:

            • using scripts and role plays to develop skills;

            • empowering students to take action by knowing what to do when they witness other students engaged in acts of bullying or retaliation, including                       seeking adult assistance;

            • helping students understand the dynamics of bullying and cyberbullying, including the underlying power imbalance;

            • emphasizing cybersafety, including safe and appropriate use of electronic communication technologies;

            • enhancing students’ skills for engaging in healthy relationships and respectful communications; and

            • engaging students in a safe, supportive school environment that is respectful of diversity and difference.

           Specific bullying prevention and awareness activities for the 2010-2011 school year include:

            •Joe The Byker Anti-Bullying assembly presentation (September 2010)
•PowerPoint Presentation on Bullying and Bullying Prevention  (May 2010)
•PowerPoint Presentation handout on Bullying and Bullying Prevention (September 2010)
•Advisory curriculum coverage of bullying, bullying prevention, conflict resolution, and healthy relationships (September and October 2010)
•Boys Town coverage in Advisory curriculum (September 2010)
•International Night: An Evening of Diversity and Cultural Awareness (February 2011)
•Student (and family) surveys on bullying and school safety (September 2010)

NLCS is currently researching state approved, research-based, age-appropriate curricular models for the 2011-2012 school year. 

B. General teaching approaches that support bullying prevention efforts.              
The following approaches are integral to establishing a safe and supportive school environment.
These underscore the importance of our bullying intervention and prevention initiatives:
• setting clear expectations for students and establishing school and classroom routines;
• creating safe school and classroom environments for all students, including for students with disabilities, lesbian, gay, bisexual, transgender students, and homeless students;
• using appropriate and positive responses and reinforcement, even when students require discipline;
• using positive behavioral supports;
• encouraging adults to develop positive relationships with students;
• modeling, teaching, and rewarding pro-social, healthy, and respectful behaviors;
• using positive approaches to behavioral health, including collaborative problem solving, conflict resolution training, teamwork, and positive behavioral supports that aid in social and emotional development;
• using the Internet safely; and
• supporting students’ interest and participation in non-academic and extracurricular activities, particularly in their areas of strength.

Bullying prevention and civic responsibility activities for the 2010-2011 school year include:
•Leadership Week (September 2010 and May 2011): a week of team building, community building, and community service activities.
•Community service activities such as Read Aloud with a local day care center; breast-cancer awareness; and, supporting animal shelters and Humane
        Society, among others.
•Demonstrating Boys Town principles of respect, accountability, and civility in daily conduct in school, on school grounds, and at school functions.
•Displaying bully prevention boxes, to be placed outside the offices of the Principal, Assistant Principal, and Counselors, in which students can write                 suggestions for bullying prevention lessons and activities.

IX.  Access to Resources and Services
A. Identifying resources.  
NLCS currently uses the following agencies for referrals and consultation.  This list is periodically reviewed and amended:

Department of Children and Family Services; 140 High Street, 4th floor; Springfield, MA  01103;
413-452-3200

Valley Mental Health; 26 Mulberry Street; Springfield, MA  01105; 413-439-0576

Child Guidance; 50 Maple Street; Springfield, MA; 413-732-7419

MSPCC; 235 Chestnut Street; Springfield, MA  01105; 413-734-4978


B. Counseling and other services.           
NLCS is currently in the process of identifying additional resources for referrals, counseling, advocacy, and trainings.

C. Students with disabilities.               
As required by M.G.L. c. 71B, § 3, as amended by Chapter 92 of the Acts of 2010, when the IEP Team determines the student has a disability that affects social skills development or the student may participate in or is vulnerable to bullying, harassment, or teasing because of his/her disability, the Team will consider what should be included in the IEP to develop the student's skills and proficiencies to avoid and respond to bullying, harassment, or teasing.

D. Referral to outside services.              
NLCS is currently in the process of developing a referral protocol for referring students and families to outside services specific to safety training, violence and bullying prevention, and advocacy.


X.       Collaboration with Families
A. Parent education and resources.        
NLCS will offer education programs in connection with any research-based bullying prevention curriculum the school adopts.  This curricular model has not been identified at the time this plan was written.  The parental programs will be offered in collaboration with the Parents Teachers Organization and the School Centered Decision Making Team.

B. Notification requirements.                
Each year NLCS will inform parents or guardians of enrolled students about the bullying prevention curricula that are being used.  This notice will include information about the dynamics of bullying, including cyber-bullying and online safety.  NLCS will also provide parents with the school’s Internet safety policy.  All notices and information made available to parents or guardians will be in hard copy and electronic formats, and will be available in English and Spanish. NLCS will post the bullying prevention plan and related information on its website.

XI. Relationship to Other Laws
Consistent with state and federal laws, and the policies of NLCS, no person shall be discriminated against in admission to a public school of any town or in obtaining the advantages, privilege and courses of study of such public school on account of race, color, sex, religion, national origin, or sexual orientation. Nothing in the NLCS’s bullying prevention plan prevents the school or district from taking action to remediate discrimination or harassment based on a person’s membership in a legally protected category under local, state, or federal law, or school or district policies. In addition, nothing in the Plan is designed or intended to limit the authority of the school or district to take disciplinary action or other action under M.G.L. c. 71, §§ 37H or 37H., other applicable laws, or local school or district policies in response to violent, harmful, or disruptive behavior, regardless of whether the anti-bullying plan covers the behavior.






Appendix A
NEW LEADERSHIP CHARTER PUBLIC SCHOOL
BULLYING PREVENTION AND INTERVENTION INCIDENT REPORTING FORM

1.   Name of Reporter/Person Filing the Report: __________________________________________________________
    (Note: Reports may be made anonymously, but no disciplinary action will be taken against an alleged aggressor solely
      on the basis of an anonymous report.) 
      

2.   Check whether you are the:  Target of the behavior  Reporter (not the target)

3.   Check whether you are a:          Student        Staff member (specify role) ________________________________

           Parent        Administrator                Other (specify) _______________________

4.   Your contact information/telephone number:_________________________________________________________

5.   Information about the Incident:

Name of Target (of behavior): ___________________________________________________________________ 

Name of Aggressor (Person who engaged in the behavior): ____________________________________________

Date(s) of Incident(s):  ___________________________________________________________________________

Time When Incident(s) Occurred: _______________________________________________________________

Location of Incident(s) (Be as specific as possible): ____________________________________________________


6.   Witnesses (List people who saw the incident or have information about it):

Name: _________________________________________      Student   Staff   Other ________________________

       Name: _________________________________________      Student   Staff   Other ________________________

       Name: _________________________________________      Student   Staff   Other ________________________


8. Describe the details of the incident (including names of people involved, what occurred, and what each person did and said, including specific words used).  Please use additional space on back if necessary.










FOR ADMINISTRATIVE USE ONLY

9. Signature of Person Filing this Report: ___________________________________________ Date: ______________
(Note: Reports may be filed anonymously.)

10:  Form Given to: __________________________________   Position: ______________________ Date: __________

Signature: ______________________________________________________ Date Received: ______________







Appendix B
NEW LEADERSHIP CHARTER PUBLIC SCHOOL
BULLYING PREVENTION AND INTERVENTION INVESTIGATION FORM

1.Investigator(s):___________________________________________________Position(s):________________________

2.Interviews:  
□ Interviewed aggressor Name: ___________________________________       Date: ___________________
□ Interviewed target              Name: ___________________________________Date: ___________________
□ Interviewed witnesses        Name: ___________________________________Date: ___________________
                          Name: ___________________________________Date: ___________________

3.Any prior documented Incidents by the aggressor?                      □ Yes□ No
  If yes, have incidents involved target or target group previously?    □ Yes □ No
         Any previous incidents with findings of BULLYING, RETALIATION         □ Yes□ No

  Summary of Investigation:






(Please use additional paper and attach to this document as needed)

III. CONCLUSIONS FROM THE INVESTIGATION
1. Finding of bullying or retaliation:

      □ YES     □ NO
             □ Bullying        □ Incident documented as ___________________________
             □ Retaliation   □ Discipline referral only_____________________________
2. Contacts:
     □ Target’s parent/guardian                      Date:_____________________
              □ Aggressor’s parent/guardian                Date: ____________________
              □ District Equity Coordinator (DEC) Date: ____________________
              □ Law Enforcement                               Date: ___________________
___
3. Action Taken:
              □ Loss of Privileges     
              □ Detention   
              □ Outside referral   
              □ Suspension       
              □ Community Service   
              □ Other ________________________________

4.  Describe Safety Planning:  _____________________________________________________________________________

              Mediation between Aggressor and Target______________________________________         Initial and date when completed: _________
              Follow-up with Target:                            Scheduled for __________________________         Initial and date when completed: _________
              Follow-up with Aggressor:                      Scheduled for __________________________         Initial and date when completed: _________
              Report forwarded to Principal:                 Date__________________________________            
              Report forwarded to Superintendent:        Date__________________________________
              (If principal was not the investigator)   

             Signature and Title: ___________________________________________________________   Date: _________________

Parent Involvement Survey