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Bully Reporting

Your Name (reporter)*

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Who was bullied? (Name and Grade of victim)*

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Who did the bullying? (Name and Grade of alleged bully)*

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When did the bullying happen? (Date)*

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Where did the bullying happen? (Location)*

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Type of Bullying*

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Verbal

Non-verbal

Physical

Cyber-bullying

Other:

Briefly describe the incident*

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Are there any other people we should talk to about this? (Witnesses)

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Any other information that you would like to share

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