Bullying Report Form
SECTION 1: Your information (optional)
Your name (optional)
Your email address (optional)
Your phone number (optional)
Please check which of the following best describes you.
I am the target of the behavior.
I am a reporter (not the target).
Please check which of the following best describes you
I am a student.
I am a parent or guardian.
I am a staff member.
SCTION 2: About the bullying
Name of target
Name of aggressor / bully
Name of witness(es) - if applicable
Date(s) of incident(s)
Time(s) when incident(s) occurred
Location(s) of incident(s)
Describe the details of the incident(s), including names of people involved, what occurred, what each person said or did - please use specific words if possible.
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