Richland-Bean Blossom Community School Corporation Bullying Form: Please complete all of the areas below that you can. Information that is (*) starred is required. Thank you.

Who Are You?

Person Reporting Bullying (First Name and Last Name) (*)

Please let us know your name.
What is Today's Date (*)

Please select today's date.
When did the bullying happen? (*)

Tell us when it happened.

Who Was Bullied?

Who do you think was bullied? (First Name and Last Name) (*)

Please let us know the bully's name.
Where does this person attend school?

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Who is this person's teacher?

Please write a subject for your message.
What grade?

Who Is The Bully (or Bullies)?

Who do you think was bullying? (*)

Please let us know the person's name.
What grade?

Please let us know your name.
Type of Bullying (check all that apply) (*)

Select one type.
Where did the bullying happen? (check all that apply) (*)

Tell us where the bullying happened.

Other Information

Is this the first time that this has happened? (*)

Please answer this question.
Have you filed a Student Bullying Report before? (*)

Please answer this question.
Who has been told about the bullying or saw what happened? (check all that apply) (*)

Please tell us this.
Any other information that you would like to share?

Please 'Type the (security) Text' in the space below and click the 'Send' button. (*)

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Our mission is to work in cooperation with the community and families to provide students with an education that promotes responsible citizenship and encourages problem solving and creativity.