Bully Reporting Form
This is a place for you to submit a concern or problem with a bully. It can be filled out with your name or not a name of who is submitting this form. Please remember that it is very important to give as much detail as possible when reporting. Also, giving your name will help us to get more details. No one will know who reported except for school administrator.
Name of person being bullied: First & Last *
Your answer
Date: *
Your answer
Name of bully: *
Your answer
Your name *
Your answer
I am a: *
Type of Bullying (Select all that apply): *
Description of events: (Please be specific-Location/Date/Time): *
Your answer
Did you witness the bullying? *
List other students/staff who witnessed the bullying… *
Your answer
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