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This form can be used for students to help document their perception of a bullying event. The students should be told to give the completed form to their teacher or designated staff member.
Given a form to complete with/without adult support, to report an incident of perceived bullying, STUDENT will complete the form, or explain to an adult what occurred, who did the bullying, and where it took place, as an event occurs within the school setting, by MONTH, YEAR.
This item is recommended for the following grade levels:

PreK, Kindergarten, 1st Grade, 2nd Grade, 3rd Grade, 4th Grade, 5th Grade, 6th Grade, 7th Grade, 8th Grade, 9th Grade, 10th Grade, 11th Grade, 12th Grade

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