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Required
ETR Bullying Prevention Student Reporting Form
Full Name
Date
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required
Grade
*
required
Homeroom
*
required
Teacher
*
required
I was...*
the target of bullying
a helpful bystander
the bully
Where did this happen?
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required
Time
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required
Day/Date
*
required
What happened? Use full names if possible and include as much detail as possible.
*
required
Is this the first time the person has bothered you?
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required