District Reporting of Bullying, Harassment & General Safety Concerns

COMPLETE REQUIRED FORMS FOR 2024-25
The window for completing your student’s required forms for the 2024-2025 school year is now open. Log into PowerSchool to access forms. Call the District Office at 740-927-6926 for assistance. ALL FORMS MUST BE COMPLETED BY FRIDAY, AUGUST 9, 2024. 

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District Reporting of Bullying, Harassment & General Safety Concerns

District Reporting for Bullying, Harassment & General Safety Concerns

Bullying Report
Harassment, intimidation, or bullying behavior by any student in the Licking Heights School District is strictly prohibited, and such conduct may result in disciplinary action, including suspension and/or expulsion from school. "Harassment, intimidation, or bullying", in accordance with R.C. 3313.666 means any intentional written, verbal, graphic or physical act including electronically transmitted acts, either overt or covert, by a student or group of students toward other students, including violence within a dating relationship, with the intent to harass, intimidate, injure, threaten, ridicule, or humiliate. Such behaviors are prohibited on or immediately adjacent to school grounds, at any school-sponsored activity, on school-provided transportation, or at any official school bus stop.

Bullying & Harassment Reporting
Bullying or harassment can be reported using the following forms. Please note the forms must be submitted to the school which the student attends.


General Safety Concern Form

The purpose of the general concern form is to address specific issues of concern that fall outside of bullying/harassment and Title IX. This form is specifically regarding high level concerns (for example, specific safety concerns). It is not intended as just a general complaint form. Please ensure that the form is completed in its entirety. It should be directed to both building principals, and the compliance officers for the district, Jocelyn Cosgrave, Director of Human Resources ([email protected]), as well as Mitch Tom, Supervisor of Pupil Services ([email protected])

Licking Heights Local School District

6539 Summit Road Pataskala, OH 43062
P: 740-927-6926 | F: 740-927-9043


Licking Heights High School (9-12)

4101 Summit Road Pataskala, OH 43062
P: 740-964-9005 | F: 740-927-0508


Licking Heights Middle School (7-8)

4000 Mink Street Pataskala, OH 43062
P: 740-927-9046 | F: 740-927-3197

Central Intermediate (5-6)

6565 Summit Road Pataskala, OH 43062
P: 740-927-3365 | F: 740-927-5845


South Elementary (1-4)

6623 Summit Road Pataskala, OH 43062
P: 740-964-1674 | F: 740-964-1625


West Elementary (1-4)

1490 Climbing Fig Blacklick, OH 43004
P: 614-864-9089 | F: 614-501-4672

North Elementary (K)

6507 Summit Road Pataskala, OH 43062
P: 740-927-3268 | F: 740-927-5736


Central Preschool

6565 Summit Road Pataskala, OH 43062
P: (740) 927-3268


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