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Anonymous Bullying Report
Please report any and all bullying that is taking place in the school building during school hours. Remember that bullying is unkind, unwanted behavior that is intentional and habitual.
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* Indicates required question
Offender Name
Your answer
Offender Grade
Choose
Pre-K
Kindergarten
1st
2nd
3rd
4th
5th
6th
7th
8th
Offender Description
*
Your answer
Witness Name (optional)
Your answer
Witness Contact (optional)
Your answer
Incident Date
Your answer
Incident Description (Please include suspected bullying behavior)
*
Your answer
Have you noticed the behavior repeating over time?
*
Yes
No
If yes, how many times have you witnessed the behavior?
0-3
4-7
8 or more
Clear selection
Has this behavior been perpetrated to other victims?
*
Yes
No
If yes, how many other students have you witnessed experiencing this behavior?
0-3
4-7
8 or more
Clear selection
Have you reported an incident for this victim or offender previously?
Yes (victim)
No (victim)
Yes (offender)
No (offender)
Clear selection
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