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Bullying Prevention and Intervention - Parent/Guardian and Student Reporting Form

Required

Please complete this form if you are aware of an incident of potential bullying. Reports may be made anonymously, but no disciplinary action will be taken against an alleged aggressor solely on the basis of an anonymous report.

Must contain a date in MM/DD/YYYY format
Type of behavior -- please check all that apply:required
Did physical injury result from the incident?required
Did the injury require medical attention?required
Was the target/victim absent from school as a result of the incident?required
If you wish to be contacted about this incident, please enter your name, email, and phone number below.
Name
First Name
Last Name

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