LOPEZ MIDDLE SCHOOL BULLYING PREVENTION PLAN
Lopez Middle School Bullying Prevention Vision Statement:
Lopez is…..
 A family of learners where students, staff, and community will work together to
promote the highest level of persona; achievement and respect for each other
 A place where all are given the opportunity to share and learn from each other
 A campus that fosters the intellectual, social, academic, and physical well being of
our students
 An environment that is safe and nurturing through the practice of integrity and
honesty
 A community that respects the uniqueness of its members
In addition, we will do everything possible, both as individuals and as a campus, to create and
preserve this environment through proactive bullying prevention education.
Bullying, as defined on page 100 of the student/parent handbook, is: Engaging in written or
verbal expression, expression through electronic means, or physical conduct, including a gesture,
that a school district board of trustees or the board’s designee determines:
1. will have the effect of physically harming a student, damaging a student’s property, or placing
a student in reasonable fear of harm to the student’s person or of damage to the student’s
property; or
2. is sufficiently severe, persistent, or pervasive enough that the action or threat creates an
intimidating, threatening, or abusive educational environment for a student.
Harassment is threatening to cause harm of bodily injury to another student, engaging in sexually
intimidating conduct, causing physical damage to the property of another student, subjecting
another student to physical confinement or restraint, or maliciously taking any action that
substantially harms another student’s physical or emotional health or safety.
The following actions may be categorized as bullying by an administrator or counselor,
especially if they are severe, persistent or cause a disruption on the school campus.
 Any physical contact that would hurt or injure a person like hitting, kicking, punching, etc.
 Taking something that belongs to someone else and destroying it would also be considered a
type of physical bullying.
 Intent to harm another student by name-calling, teasing, making offensive remarks, or joking
about a person’s religion, gender, ethnicity, sexual orientation, socioeconomic status, or the
way they look.
 Spreading rumors or stories about someone, telling others about something that was told to
you in private, and excluding others from groups.
 Threatening someone else and frightening that person enough to make him or her do what the
bully wants.
 Sending messages, pictures, or information using electronic media, computers (email & instant
messages, Facebook, etc), or cell phones (text messaging & voicemail) with intent to harm
another student.
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Any student who believes they have been bullied or who has seen another student being bullied
should report the problem immediately to a teacher or other adult on campus. Furthermore, a
Lopez Middle School employee or parent who witnesses a bullying incident should report it to a
campus administrator or counselor. Strict confidentiality will be observed.
For any violation of the Bullying Prevention Plan, the following steps will be taken by the staff at
Lopez in sequential order for each violation that occurs. *Note: It is possible to have more than
one step for a student depending on the nature and severity of the behavior.
Reporting: The staff member who receives the report will use the Bullying Documentation Form.
1. Affirm the student’s feelings
o “You were right to report/get help from an adult.”
o “I’m glad you asked for help with this.”
2. Ask questions
o “Tell me more about what happened.”
o “Has this happened before?”
3. Assess the student’s safety. Determine what the student needs in order to be safe now.
4. Act – refer Bullying Documentation Form to the Counseling Department unless there was
actual physical contact, then please refer directly to an administrator. This referral will
be in writing on the Bullying Documentation Form by the teacher.
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Step 1: (First Referral) Meet with Counselor (unless there was physical contact)
Both the student that reported the bullying and the student that was reported as the victim will
meet with their counselor separately to discuss the problem, solutions to the problem, and to
reinforce that bullying will not be tolerated.
 If the Counselor decides that mediation is necessary then the Counselor will mediate the
situation with both students together. The counselor will then document on an LP
Mediation Form and give a copy to the appropriate alpha administrator.
 The Counselor will warn the student who is bullying that the next incident will result in his
or her parent being contacted and possible disciplinary action.
 The Counselor will have the student who was bullying sign the LP Bullying Contract and give
a copy to the appropriate alpha administrator
End Result: Warning given, Bullying Contract signed.
Step 2: (Second Referral) Meet with Administrator, Contact Parents
Administrator will talk with the student who is bullying and notify a parent/caregiver of the
involved students. The parents of the student who is bullying will be informed that the next
bullying incident will result in a meeting with the student, one of their parents and an
administrator as this would be the third incident, consequences will be given and these
consequences will become part of the student’s disciplinary file. The student will be required to
sign the bullying prevention contract with a parent contacted date annotated. A copy will be
given to the appropriate alpha counselor. The parent of the victim will be notified and encouraged
to have their child report any further incidents and that the next incident will in fact result in
consequences.
End Result: Parent contacted, student and parent notified next incident results in discipline.
Step 3: (Third Referral) Formal Meeting with Parent, Student and Administrator
Administration will notify the parents of the involved students. The parent/caregiver of the
student who is bullying will be asked to meet with the school administrator. Previous
documentation will be reviewed with parent/s and student. The student will be required to sign
the bullying prevention contract again with one of their parent/guardian signatures as a witness.
Administration will give a disciplinary consequence for this third bullying incident, which will go
on the students permanent record. Administration will give a copy to the appropriate alpha
counselor for their file on the student. Any further bullying infractions will result in additional
disciplinary action on the part of administration.
End Result: Meeting with Parent, Administrator and student, punishment given.
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Lopez Counseling Mediation Form
DATE:
Student #1:
Student #2:
Grade:
Grade:
Student #3:
Student #4:
Grade:
Grade:
REFERRED BY:
REASON FOR CONFLICT:
RUMORS
CONFRONTATION
PUSHING
PROPERTY/POSSESSION
FIGHT
NAME-CALLING
BOY/GIRL PROBLEMS
OTHER
Both students agree to:
Calm down
Think before acting
Weigh consequences
_____Talk before taking action
Think of solutions
Ignore rumors
Realize THEY make all of their choices and THEY are responsible for the
consequences ______Work on communication skills
Signature of student #1
Signature of student #2
Signature of student #3
Signature of student #4
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Other
Recognizing the Difference
Normal Conflict
Bullying
Counselor Conducts Mediation/Counseling
Meeting with Counselor then Administrator
Happens occasionally
Repeated negative actions
Usually friends or acquaintances
Usually not friends or acquaintances
Accidental
Purposeful
Not severe
Severe threats of physical and/or
emotional harm
NOT seeking power, attention, or
material things
Attempt to gain power, attention, or
material things
Takes responsibility and tries to
solve the problem
Blames the victim and makes no
effort to solve the problem
Definition of Bullying: Bullying, as defined on page 100 of the
student/parent handbook, is: Engaging in written or verbal expression,
expression through electronic means, or physical conduct, including a
gesture that a school district board of trustees or the board’s designee
determines:
1. will have the effect of physically harming a student, damaging a
student’s property, or placing a student in reasonable fear of harm to the
student’s person or of damage to the student’s property; or
2. is sufficiently severe, persistent, or pervasive enough that the action
or threat creates an intimidating, threatening, or abusive educational
environment for a student.
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Bullying Documentation Form
(A copy will be given to Counseling or Administration)
Reporting Staff member:
Date:
Description of violation:
Students involved:
_______________________________________
_______________________________________
_______________________________________
_______________________________________
_______________________________________
ID
ID
ID
ID
ID
#
#
#
#
#
Grade
Grade
Grade
Grade
Grade
Counselor has students write statements on school statement form
1st offense
Referral to Counselor, unless there was physical contact, then refer to Administration
Date:
Counselor will provide a copy to Administration.
2nd offense
Referral to Administrator – Date:
Administration will provide a copy to Counseling.
3rd offense
Referral to Administrator – Date:
Administrator will provide a copy to Counseling.
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LOPEZ MIDDLE SCHOOL
STUDENT STATEMENT FORM
USE INK ONLY
Please describe in your own words what you observed. Be as factual and specific as you can. Try not to
reach conclusions or make judgments. Use names when possible to identify the person you are referring to
in your statement.
Please provide the names of other witnesses/students if you know them, or give a description of the
individual to help identify the individual.
Please print your name:
Signature:
Date:
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Lopez Bullying Contract
Counselor Form
I,
, understand that my previous behavior is by
definition bullying, and I fully understand the Lopez Middle School bullying prevention policy. I have also
been made aware of the consequences that will be enforced if my bullying behaviors continue. Therefore, I
promise that I will make every effort to keep our school a safe and caring place by stopping my bullying
behaviors and following these simple rules:
1.
2.
3.
4.
5.
6.
7.
Treat everyone with kindness and respect.
Resolve disagreements with other students peacefully.
Never tease, hurt, name-call; bully another student or pass on harmful rumors.
Refuse to join in if I see someone else being bullied; shunned or put down.
Do not laugh when you see bullying; instead try to say it is wrong.
Ask for help from an adult if I am bullied or see someone else being bullied.
Practice new, kind behaviors, and ask for help when I don’t know how to handle a
situation.
Student Signature:
Grade:
Counselor’s Signature:
Date:
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Lopez Bullying Contract
Administrator Form
I,
, understand that my previous behavior is by
definition bullying, and I fully understand the Lopez Middle School bullying prevention policy. I have also
been made aware of the consequences that will be enforced if my bullying behaviors continue. Therefore, I
promise that I will make every effort to keep our school a safe and caring place by stopping my bullying
behaviors and following these simple rules:
1.
2.
3.
4.
5.
6.
7.
Treat everyone with kindness and respect.
Resolve disagreements with other students peacefully.
Never tease, hurt, name-call; bully another student or pass on harmful rumors.
Refuse to join in if I see someone else being bullied; shunned or put down.
Do not laugh when you see bullying; instead try to say it is wrong.
Ask for help from an adult if I am bullied or see someone else being bullied.
Practice new, kind behaviors, and ask for help when I don’t know how to handle a
situation.
Student Signature:
Grade:
Administrator’s Signature:
Date:
Parent Contacted on this date:
Parent’s name: ___________________________________
Parent Signature:
Date:
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