HMS Bully Report
Please use this to report bullying behavior that is happening to you or someone you know. If this is an EMERGENCY, please stop now and call 911.
Name of student REPORTING the bullying:
(You do not need to leave your name.)
Name of student DOING the bullying:
Name of student who WAS bullied:
Grade level of students involved:
Please check all that apply.
Where did the bullying happen?
(choose all that apply)
Please explain what happened:
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This form was created inside of DeKalb CUSD428.