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Bully Report Form


This form may be used by anyone who experiences or witnesses bullying of a student.  Fill out the form completely and click the SUBMIT button to alert school safety teams.


Today's Daterequired
Must contain a date in M/D/YYYY format
Name of person completing this formrequired
First Name
Last Name
Email Address
I am arequired
Did you witness the bullying?required
Name of the person being bullied.required
First Name
Last Name (optional)
What school does this person attend?required
What date did the bullying occur?
Must contain a date in M/D/YYYY format
What type of bullying occured?required
Describe in detail what happened. Be specific-use exact wording, names, dates, location, time, etc.required
List anyone else who may have witnessed the incident described above.
What steps have already been take to help in the situation?
Is this the first time you have reported the bullying?required