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Bullying Report Form
Below record the appropriate information:
Your Name: *
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Choose Your Role: *
Your Telephone Number: *
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Your Email Address: *
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School where incident occurred: *
Names of Person (s) you believe committed bullying: Offender *
Your answer
State the nature of your report. Please describe the action(s)/incident(s) you believe may be in violation of the District's anti-bullying policy as clearly as possible, including such things as what physical force or contact, if any, was used and any verbal statements that were made (i.e. threats, requests, demands, etc.): Nature *
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If others are affected by this possible violation, please also give their names and/or positions: *
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Where did the incident(s) occur? *
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Please list any witnesses who were present, or others who may have information regarding the incident(s):Witness *
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Please provide other information relevant to this incident of bullying. Other Information. *
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