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Report A Bully
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Your Name
Your answer
I am a
*
Student
Parent
Teacher
Other:
Where did the incident occur?
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Choose
In Class
At Recess or Lunch
On the bus
On the Phone
Text Message
Social Media
Other
When did it happen?
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MM
/
DD
/
YYYY
How many times has this situation happened?
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Choose
First time
One other time
Once a month
Once a week
Everyday
Have you reported this incident to an adult?
*
Yes
No
Who was bullying, harassing, intimidating or causing harm? (Include first name, last name and grade if known)
Your answer
Describe what happened. Give as much information as you can. Let us know if there were any witnesses.
*
Your answer
If you would like someone to contact you, please add your email or phone number here. (Optional)
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