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Items denoted with an asterisk * are required.
I am a: * Student Parent/Guardian Community Member Staff Member The Person Being Bullied
Your Name (Optional)
Date*
WHAT (specifically) is happening? Use names of everyone involved *
WHEN is it happening? Be specific. Is it every day, after school, once a week, etc.? Give exact time, if possible *
Bystanders (other witnesses). Include the Grade and/or Class *
Please leave any other information