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CHS/CJH - Bullying Report Form
IF YOU OR SOMEONE ELSE IS IN IMMEDIATE DANGER, CALL 911.
Complete this form if you have credible information regarding a bullying or harassment incident.

(Note: Reports may be made anonymously, but no disciplinary action will be taken against an alleged aggressor solely on the basis of an anonymous report.)

IF YOU OR SOMEONE ELSE IS IN IMMEDIATE DANGER, CALL 911.
Complete this form if you have credible information regarding a bullying or harassment incident.

(Note: Reports may be made anonymously, but no disciplinary action will be taken against an alleged aggressor solely on the basis of an anonymous report.)

Your Name (optional):
Your answer
Check whether you are the:
Check whether you are a:
Your phone number (optional):
Your answer
If you are a student, please select your grade:
Have you submitted a bullying report form previously?
Name or description of victim(s):
Your answer
Name or description of student(s) bullying:
Your answer
Names or descriptions of witnesses/bystanders:
Your answer
Date(s) of the incident(s)?
Your answer
Time when the incident(s) occurred:
Your answer
Location of the incident(s): (be as specific as possible):
Your answer
Describe the specific details of the incident:
Your answer
Was this reported to the school administration?
If you answered yes to the previous question, when was it reported and who did you speak to?
Your answer
By submitting this form, you are verifying that your statements are true and accurate to the best of your knowledge.
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