Get Rule 5580, Form A - Bullying, Harassment, And Intimidation Form

Filling out the Rule 5580, Form A is a crucial step in reporting incidents of bullying, harassment, or intimidation. This guide will provide you with a clear, step-by-step process for properly completing the form online, ensuring that you can effectively communicate your concerns.

Follow the steps to complete the form online efficiently.

1. Press the ‘Get Form’ button to obtain the form and open it in the online editor.
2. Begin by entering today’s date in the designated section. Provide the month, day, and year.
3. Fill out the school name and school system in the corresponding fields.
4. In the section titled 'Person Reporting Incident', enter your name, telephone number, and email address.
5. Select the appropriate checkbox to identify your relationship to the student involved, whether you are a student, parent/guardian, close adult relative, school staff, or bystander.
6. Provide the name and age of the alleged student victim. If there are witnesses, include their names in the next fields.
7. List the names of any alleged offenders, including their schools and ages.
8. Indicate the date(s) on which the incident(s) took place by filling out the month, day, and year for each occurrence.
9. Select all applicable statements that best describe the bullying, harassment, or intimidation incident that occurred.
10. Choose all locations where the incident happened, such as on school property, on a school bus, or via the internet.
11. In the description field, provide a detailed account of the incident, including specific actions and words used by the alleged offender(s).
12. Explain the reasons behind the bullying, harassment, or intimidation in the designated section.
13. Indicate whether there were any physical injuries as a result of the incident, and if medical attention was needed.
14. If there was a physical injury, answer whether there will be any permanent effects.
15. Confirm whether the student victim was absent from school due to the incident and specify the number of days, if applicable.
16. Identify if a psychological injury occurred and whether psychological services were sought.
17. Provide any additional information that may be relevant to the incident.
18. Sign the form and include the date of signature.

Take action today—fill out your Rule 5580, Form A online and report bullying, harassment, or intimidation.