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Bully Reporting Form

Person Reporting the Incident

Who is submitting this form?*
Please tell us who you are
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Are you the:*
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Incident Information

Victim Information

School:
What school does the victim attend? (if known)
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Grade
What grade is the student(s) at school? (If known)
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Alleged Bully Information

School:
What school does the offender attend? (if known)
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Grade:
What grade is the student(s) at the school? (if known)
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Details of Incident

Where did the incident occur?*
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What statement best describes what happened?*
Check all that apply
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Disclaimer*
By submitting this form you acknowledge that the information entered is complete, true, and accurate. Please note that whoever engages in any conduct with intent to convey false or misleading information under circumstances where such information may reasonably be relied upon and where such information indicates that an activity has taken, is taking, or will take place would constitute a violation of law and the submitter of such information may be prosecuted.
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