MTLSD Bullying Report Form

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Mt. Lebanon School District Online Bullying Hotline Reporting Form

The school I attend is: *

What is your Last name? *

What is your First name? *

What is the Last name of the bullying victim? *

What is the First name of the bullying victim? *

When did you witness the bullying incident? *

YYYY

What time did it occur? *

Time

Where did it occur? *

What is the Last name of the person doing the bullying? *

What is the First name of the person doing the bullying? *

Please describe the bullying behavior in as much detail as possible: *

What is the best way to contact you? *

At school- I am a student

Telephone

Other:

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