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Harassment, Intimidation, Hazing, and Bullying Report

 
Your Information (optional)
Name
First Name
Last Name
Email Address
Phone #
Incident Information
When did this incident happen?
Must contain a date in M/D/YYYY format
Location of Incident:
Additional Location Information
Please enter more information about the location on the incident.
Your Role
Please enter any additional information about how you were involved or how you know of the incident.
Type of harassment, intimidation, hazing, bullying or harm:
Cause of harassment, intimidation, hazing, bullying or harm:
Method of harassment, intimidation, hazing, bullying or harm:
What is the victims age/or grade?
Who was the person being harassed, intimidated, hazed, bullied or harmed?
What is the offenders age and/or grade?
Description:
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.