Bullying, Harassment or Intimidation
* Required
Today’s Date
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MM
/
DD
/
YYYY
Your Name or Anonymous
*
Your answer
Telephone
*
Your answer
Email
Your answer
I am:
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Staff
Student
Parent
Community Member
I am also:
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Person who was bullied
Person who witnessed bullying
Person who participated in bullying
Person who is concerned about bullying
N/A
Have you previously reported bullying behavior?
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Yes
No
If yes, then to whom?
Your answer
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