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Bullying Complaint Form
Test
Please tell us your Name (Optional, but very helpful.)
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I am a
What happened to you or what did you witness? Be as specific as possible.
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Name of student(s) who is/are bullying you or someone you else?
Your answer
Name(s) of student(s) being bullied.
Your answer
Names of any witnesses.
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Where did this incident take place? Please be specific regarding exacting were the incident occurred.
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Please be specific regarding exactly where the incident occurred. (In school and outside of school)
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When did this incident take place? (Date and Time)
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Does any adult in the building know about this? If yes, please provide their name(s).
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Disciplinary Action Taken (Faculty Only)
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Internal Comments (Faculty Only):
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