Perquimans County School Anonymous Incident/Bullying Report
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Name (Optional)
Contact Information (Optional)
Location of Incident *
Location (Other) Please describe
Date of Incident
Describe the incident in detail
Have you talked to a teacher or administrator about the problem? *
Would you like to talked to the counselor or administrator about the problem? *
If you answered yes to the last question, please leave contact information.
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