Bullying Form
"Bullying" means the repeated use by one or more students of a written, oral or electronic communication, such as cyberbullying, directed at or referring to another student attending school in the same school district or a physical act or gesture by one or more students repeatedly directed at another student attending school in the same school district.
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Person reporting this incident *
Required
Reporter's Name   
Reporter's Contact Information  
Time and location of alleged act(s) *
Description of the alleged act(s) *
Name(s)/Ages/ School of person(s) alleged to have committed above act(s) (if known) *
Name(s)/Ages/ School of witnesses (if any/if known) *
What physical evidence, if any, can you provide? (This may include social media evidence) *
Have there been previous incidents? *
If "yes", please describe the behavior of concern, the approximate dates, and the location: *
Were these incidents reported to school personnel? *
If "yes", to whom was it reported? *
Was the report verbal or written? *
Indicate your opinion on how this problem might be resolved. Be as specific as possible. *
I certify that the above information and events are accurately depicted to the best of my knowledge.
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