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Bullying Incident Report Form
Anonymous bullying reporting form for Southeast Local School District.
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* Indicates required question
Date of the incident
*
Your answer
Your name (Optional)
Your answer
Your grade
*
Your answer
Bully's name
*
Your answer
Bully's grade
*
Your answer
Nature of the incident: (I was bullied, I saw bullying occur, etc)
*
Your answer
Where did the bullying happen? (Hallway, Bathroom, Auditeria/Cafe, Outside, Social media, Cell Phone, Bus, Locker Room/Gym)
*
Your answer
When did the bullying happen? (Period of the day, Before or after school, Passing between classes, During Class, Via Text/Voice)
*
Your answer
What happened? ( " I was..." or " I saw someone get...")
*
Your answer
What else would you like us to know about?
Your answer
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