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Please provide you name.
If you are a student, please provide your student ID number.
If you are a student, please provide your current grade level.
Please provide the name of the school you attend.
Relationship between you and the alleged bully, and/or cyber-bully:
When and where did it happen?
If you reported that there were witnesses, then please provide their names below:
Please type your name and today's date below:
I certify that all statements made in complaint are true and complete. Any intentional false statement of fact will subject me to appropriate discipline.