Restorative Meeting with Ms. Torres ❤️

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Please fill out this form to make an appointment to speak with Ms. Torres. Contact me if you feel unsafe in school, need to report bullying, you are having a problem with someone at school, or you would like a one-on-one meeting.

Email *

Record my email address with my response

First and Last Name *

Date: *

YYYY

Grade: *

6th

7th

8th

Student ID: *

Location of Incident: Where did this happen? *

Classroom

200 Building

300 Building

Lunch Arbor

PE Area

Boys/Girls Bathroom

Secret Garden

Upstairs Bridge

Off campus

100 Building

Hallway

Other:

Required

Reason for Meeting: Check one or more boxes *

Peer Conflict: I am not getting along with someone

Bullying Report/Incident: Someone is bothering me and I am uncomfortable

Teacher/Student Conflict: I am not getting along with one of my teachers or other staff

Socio-emotional: I would like someone to talk to about what I am going through

Resources: I need help with something at school/home

Other: I have to meet about something else that is not on the list

Other:

Required

Student Declaration:

Please tell me what happened in detail: What happened? Who is involved? Where is this happening? Please explain.

Give us as much information as possible.

Send me a copy of my responses.

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