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Odyssey Community School Bullying Form
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Report of Bullying Form/Investigation Summary
Date
*
Your answer
Reporter Information
*
Anonymous student
Staff Member
Parent/Guardian
Student
If Staff member enter your name:
Your answer
If Parent or Guardian enter your name:
Your answer
If you are a student and do not want to remain anonymous enter your name:
Your answer
Describe the alleged act of what happened:
Your answer
Who committed the allleged bullying act?
*
Your answer
Who was the victim?
Your answer
Time(s) of day alleged act(s) happened:
Your answer
Frequency of alleged bullying-Explain
Example-(Only once, daily, twice a week etc.)
Your answer
Location alleged bullying ocurred
(If by electronic device, please specify type and if possible attach any supporting documents, usernames, etc.):
Your answer
Please write the name(s) of any potential witnesses.
Your answer
Please share any additional information
Your answer
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