Bullying Report Form
If you have information regarding bullying and would like to report this information anonymously, please fill out the following form to the best of your knowledge. (For the purpose of this form bullying encompasses bullying, harassment, and discrimination.)
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Date of Incident *
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YYYY
Date of Report *
MM
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DD
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YYYY
Who was the person(s) engaged in bullying? *
Grade of person(s) who engaged in bullying? *
Who was being bullied? *
Grade of person being bullied? *
What type of bullying? *
Required
Where did the incident take place? *
Required
Other location details:  (Please explain the specific location details such as which hallway, where on the Internet, what restroom, etc) *
Describe what happened with as many details as possible.
 *
(Not Required) Person reporting the incident: (OPTIONAL). Please use your full name.
May we contact you for more information on this incident?
 *
Email address or phone number where we can contact you?
Submit
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