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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.


Must contain a date in M/D/YYYY format
Name of person completing this formrequired
First Name
Last Name
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
Must contain a date in M/D/YYYY format
What type of bullying occured?required
What steps have already been take to help in the situation?
Is this the first time you have reported the bullying?required