If you are the victim simply type your name again. If you are a reporter and not the victim, type the name of the victim.
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CHECK WHETHER YOU ARE A: *
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NAME(S) OF STUDENT(S) ACCUSED OF BULLYING: *
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WHEN DID THIS INCIDENT OCCUR? (DATE) *
If multiple incidences have occurred on a different day or time, please complete a new form for each incident.
MM
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DD
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YYYY
WHEN DID THIS INCIDENT OCCUR? (TIME) approximate *
If multiple incidences have occurred on a different day or time, please complete a new form for each incident.
Time
:
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PM
WHERE DID THE INCIDENT OCCUR? *
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Describe the details of the incident (including names of people involved, what occurred, and what each person did and said, including specific words) *
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LIST ANY WITNESSES TO THIS INCIDENT BELOW: *
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Is there any other information you believe is relevant for the district to know when investigating this incident? *
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TYPE YOUR FULL NAME BELOW AS YOUR SIGNATURE: *
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