Bullying Report Form
Bullying is any unwanted aggressive behavior(s) carried out by student(s) who are not siblings or current dating partners, involving an observed or perceived power imbalance.  These behaviors are likely repeated, and target a victim based upon one or more distinguishing characteristics.
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Date of the Incident *
Time of the Incident *
Time
:
Location of the Incident *
Did it happen in a classroom? If so, what classroom? *
Did it happen in a hallway? If so, which hallway? *
Did it happen in a restroom? If so, which restroom? *
Name of the Victim(s) *
Name of the Aggressor(s) *
Type of Bullying *
Reason you believe the victim was targeted. *
Describe the Incident *
What evidence will support this report *
Required
Please list potential witnesses *
Is this the first incident? *
If no, how many times has it happened before? *
If you choose to, what is the first and last name of who is submitting this report?
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