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Date of the incident
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Time of the incident
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Is this a safeguarding, bullying or discrimination concern
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Safeguarding
Bullying
Discrimination
What Year Group is the pupil or pupils in?
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Year 7
Year 8
Year 9
Year 10
Year 11
Not sure of the Year Group
Other
If this is a bullying concern, please select the type of bullying
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Racist (racial bullying/racial abuse)
Sexist (discrimination, gender bullying)
Disability (disability bullying)
Homophobic (sexual orientation/gender)
Transphobic (gender/identity discrimination)
Verbal bullying
Physical bullying
Cyber bullying (social media/internet, using mobile or gaming devices)
None of the above
If this is a discrimination concern, please select the type of discrimination
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Race or nationality
Gender
Disability
Sexual orientation
Religion
Other
Please outline your concern with as much detail as possible (with names if known) so that we can forward your concern to the appropriate member of staff *
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