BRUNSWICK SCHOOL DEPARTMENT BULLYING REPORT FORM
Name of complainant/reporter (by law, reports may be anonymous):
I would prefer to remain anonymous
Status of reporter:
Contact information for reporter (if reporter is student, contact information for parent/guardian):
Name of alleged target(s)
Name of alleged bully(ies)
Relationship between alleged target/bully(ies)
Time(s) and location(s) of alleged incident(s)
Names of witnesses
Description of incident(s) - attach additional pages if more space is needed:
I agree that the information on this form is accurate and true to the best of my knowledge and belief.
Yes, I agree.
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