LaPoynor Anonymous Bully Report
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Campus: *
Date of the Incident *
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Date of Report *
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YYYY
Who was the person(s) engaged in bullying?
Grade level(s) of the person(s) engaged in bullying?
Who was being bullied?
Grade of the person being bullied?
Type of bullying:
Physical: hitting, touching, etc.
Emotional: making fun of, intimidating, stalking, etc.
Online: posting hurtful/embarrassing thing online, etc.
Where did the incident take place? Please give as much detail as possible.
Describe what happened with as many details as possible. What was the time of day? Did anyone else witness this incident? Have you witnessed this incident before today?
Person reporting the incident (OPTIONAL):
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