Bully Reporting Form
Location
What Campus did(is) this occur(ing) on: *
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Date of incident:
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Date Reporting
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Person bullying:
Your answer
Grade of person bullying:
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Person being bullied:
Your answer
Grade of person being bullied:
Your answer
List any bystanders/witnesses:
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Type of bullying:
Where did the incident take place? (gym/locker room/cafeteria etc.)
Your answer
When did it take place?
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Please describe what happened. Give as much detail as possible.
Your answer
List evidence of bullying if any (letters,text messages, photos, etc.)
Your answer
Person making report (optional):
Your answer
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