Bullying Report Form
If you have been  the target of bullying or have witnessed the bullying of a District student, complete this form.

Bullying is defined as an unwanted, aggressive behavior that involves a real or perceived power imbalance to control or harm another person and is repeated over time.
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Date
MM
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DD
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YYYY
Time
Time
:
Name:
Phone Number:
You are a:
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Dates of Alleged Bullying:
Name of Student Subjected to Bullying:
Person alleged to have committed the bullying or harassment:
Summarize the incident or occurrence of bullying as accurately as possible. Include specific information such as location, time of day, persons involved, etc.
Names of Witnesses:
Have you reported this to anyone else?
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If you have reported this to someone else, who did you report it to?
Submit
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