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Bolivar Intermediate School Bullying Incident Report
(Bullying Incident Report Form for Use by Parents, Students and Community Members)
Reporter (Person filing the report)
Bullying frequently involves repeated behavior. If you have witnessed or have knowledge of more than one incident, please provide information on all incidents. Please feel free to use multiple forms.
Relationship to the student being bullied:
Anonymous (It is more difficult to follow up on anonymous reports)
Did you witness this incident?
If no, provide the specific information as to how you found out about this incident:
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