Bullying Report Form
If you have been the target of bullying or have witnessed bullying at Wellington-Napoleon R-IX School District, please complete this form. Reports of bullying will be followed-up by the school counselor, and principal if necessary.
Your name (optional)
Person reporting the bullying behavior
What school is your concern in?
Name of student(s) targeted by bullying or harassment
Person(s) alleged to have committed the bullying or harrassment
Date(s) of bullying incidents
Summarize the incidents or occurrences of bullying as accurately as possible.
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