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Submit a Report

Required

(Must contain a date in M/D/YYYY format)
Your Schoolrequired

Individuals being reported as target of bullying:

Are you the target of the bullying that you are reporting today?
Are they:Please select up to 2 choices
Please select up to 2 choices

Person being reported as aggressor engaged in bullying (the bully):

Are they:Please select up to 2 choices
Please select up to 2 choices

People who witnessed the bullying:

Are they:Please select up to 2 choices
Please select up to 2 choices

Details of the Incident:

(Must contain a date in M/D/YYYY format)
Was the incident based on any of the following characteristics? (Please check all that apply)

Person reporting the incident:

**All personal information is completely optional and will be kept confidential.**

Your Name (leave this blank if you wish to remain anonymous)
First Name
Last Name
Must contain only numbers