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Online Bullying Report

Must contain a date in M/D/YYYY format
I am a:
Indicate here if you prefer to remain anonymous:
Are you the target of the bullying or school violence that you are reporting?
Must contain a date in M/D/YYYY format
Person(s) being reported as targets of bullying or school violence:
Person(s) being reported as aggressors engaged in bullying or school violence:
Person(s) who witnessed the bullying or school violence:
Was the incident based on any of these characteristics? (check all that apply)
Student(s) were targeted for bullying in the following way(s): (check all that apply)
Student(s) were targeted for bullying in the following place(s): (check all that apply)
What types of interactions occurred (physical, written, social, electronic, etc.)?
Attach up to 1 file with a maximum size of 20MB
No file chosen
Must contain a date in M/D/YYYY format