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Reporting Form
Full Name (Optional)

Address (Optional)

Phone Number (Optional)

Email Address (Optional)

(This question is mandatory)
You are a:
(This question is mandatory)
Date of incident
Open the date time chooser

Format: dd.mm.yyyy

(This question is mandatory)
Student involved in BHDR (Bullying Harasment Discrimination Report)
(This question is mandatory)
Grade of student involved in BHDR
Age of student involved in BHDR
(This question is mandatory)
School that student attends
(This question is mandatory)
Place of Incident:
(This question is mandatory)
Check the box(s) that describe the BHDR incident
(This question is mandatory)
Name of Bully or Bullies
(This question is mandatory)

Please Explain Incident In  Detail

Please provide the names of any witnesses
Witness Grade: (Optional)
Witness Age (Optional)
(This question is mandatory)

By filling out a report through this system you are asking the Dignity Act Coordinator, Ms. Dushko in the elementary school or Mr. New in the middle/high school to begin an investigation.