Bullying Reporting Form
Whether you are a witness or target in this case, we want to thank you for helping to maintain a positive safe school and a positive learning environment for all of our students.  
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Email *
Today's date *
Your Name (This report will be held confidential. Your identity will remain anonymous.) *
When did the bullying or cyber-bullying occur? (Please tell us the date it happened in  mm/dd/yyyy format)
Name of the Bully (ies) *
Name of Target(s) *
Where did this happen (For example, the bus stop, the cafeteria, on the playground, in the restroom, chromebook-(during related arts) *
Where there any witnesses? (If yes, please list their names, if you know them) *
Description (Describe what happened as clearly as possible with as many details as you can remember.) *
Did you report this to anyone? (If yes, please tell us who.) *
Grade Level *
A copy of your responses will be emailed to the address you provided.
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