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Bully Report Form

by David Geurin

February 26, 2008

Thank you for helping us keep Miller R-2 Schools a safe place to be for all students. Please provide us with as much information as you can about the bullying situation that you have witnessed. All information that you submit is confidential and no other students will ever know that you filed this report. Thank you!

Name (optional):

Name of bully:

Name of victim:

Description of bullying activities:

Others who witnessed the bullying:

 

 

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