Bullying Report Form
Instructions: Complete this form, responding only to the questions that you feel comfortable answering and are able to report accurately. This form may be completed by the person reporting the incident or by the school employee to whom the incident is being reported.
Name of Person Reporting the Incident:
Your answer
School *
Date of Report: *
Person Reporting the Incident:
Description of Incident (Include the names of those involved and as much detail as possible: what, where, when, how, etc.)
Your answer
List the name(s) of any witnesses to the incident.
Your answer
I agree that all of the information on this form is accurate and true to the best of my knowledge.
Your answer
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