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SCISD Bully Report Form

  First Name of Student Reporting This Bullying Incident

  Last Name of Student Reporting This Bullying Incident

  Telephone Number

  Email

Select which apply to you:

Student

Parent/Guardian

School Staff

Community Member


  Bully's First Name

  Bully's Last Name

  Date of Incident

  Time of Incident

Where did the incident occur?

Please add any information about how you were involved or how you know of this incident.

Please describe the bullying incident.  Try to include as many details as possible.

Disclaimer:  By submitting this form, you acknowledge that the information entered is complete, true, and accurate.  Please note that whoever engages in any conduct with intent to convey false or misleading information under circumstances where such information may reasonably be relied upon and where such information indicates that an activity has taken, is taking, or will take place would constitute a violation of law and the submitter of such information may be prosecuted.

By checking this box, you agree to the disclaimer above.

  

 

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