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Editing previous response:
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Bullying Reporting Form
Please complete the form below. Required fields marked with an asterisk *
Name of Individual Reporting (Optional)
Answer Required
Which school do you attend?
*
Answer Required
Please Select
Frederic Elementary
Frederic 6-12
Individuals Involved in the Incident
*
Answer Required
Describe what happened
*
Answer Required
Where did the incident occur? (Please list the school and the location in the school)
*
Answer Required
Were there witnesses? If so, please list names.
Answer Required
How often does the bullying occur?
Answer Required
Have you responded to the bullying?
Answer Required
Have you spoken to anyone about the incident? If so, who?
Answer Required
Who do you want to be notified about the incident?
*
Answer Required
What would you like the response to be?
*
Answer Required
I just want someone to be aware.
I want an adult to talk to the individual(s) bullying me.
I want an adult to help solve the problem.
I want an adult to try to stop the bullying without identifying myself or the bully.
Other:
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