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CS Porter Middle School Student Report (Harassment/Intimidation)
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Your Last Name
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Your answer
Your First Name
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Your answer
Who: (Name of the person (or people) harassing or intimidating you)
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Your answer
What: (Describe where this harassment or intimidation is taking place)
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Your answer
Where: (Describe where this harassment or intimidation is taking place.)
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Your answer
When: (When is the harassment or intimidation taking place? How long has this been happening?)
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Your answer
Witnesses: (Who else, besides yourself, has seen or heard what was said or done?)
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Your answer
Background Information: (Share any other information that you think will help us stop this from happening.)
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Your answer
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