JICK-E3 - BULLYING: SUMMARY OF DISCIPLINARY AND REMEDIAL ACTIONS
JICK-E3 - BULLYING: SUMMARY OF DISCIPLINARY AND REMEDIAL ACTIONS
NEPN/NSBA Code: JICK-E3
BULLYING: SUMMARY OF DISCIPLINARY AND REMEDIAL ACTIONS
This page is for use when a substantiated incident of bullying is entered into the Report of Substantiated Incident of Bullying in the Maine Department of Education’s NEO data reporting system. It is aligned with the NEO data categories.
This documentation is in reference to the alleged incident of bullying reported on:
[Date of incident]
Name of student who was found to have bullied (name is form tracking in school unit files only; do not report name of student or any personally identifying information to the Maine Department of Education)
Delineate the specific nature(s) of the incident:
Cyberbullying
Electronic expression
Physical act or gesture
Retaliation
Verbal/Oral
Written
Alternative discipline imposed for this student (actions taken):
Meeting with the student and the student's parent(s) or guardian(s)
Reflective activities, such as requiring the student to write an essay about the student's misbehavior
Mediation, but only when there is mutual conflict between peers, rather than one-way negative behavior, and
both parties voluntarily choose this option
Counseling
Anger management
Health counseling or intervention
Mental health counseling
Participation in skills building and resolution activities, such as social/emotional cognitive skills building,
resolution circles and restorative conferencing
Community service
The student received/will receive the following discipline actions (consequences):
Alternative Discipline
Detention
Weekend Detention
In-school suspension
Out-of-school suspension
Expulsion/Recommended for expulsion (middle or high school level only
The following serves as a record that a report of substantiated bullying has been submitted to the Maine Department of Education. Date:
Signature and position of person completing this form
Data reported to Maine DOE (NEO) on [Date] by
Signature, Position of Reporter
Copy to building principal on [Date]
Copy to Superintendent on [Date]
Approved: August 18, 2014
Revised: September 26, 2016
Revised: November 7, 2016
Revised: August 2, 2021
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