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Bully Box

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					                                  Bully Box
                                   Report

Your Name: __________________________________________________

Date: ________________________________________________________

Your Homeroom: _____________________________________________

Who bullied: _________________________________________________


What did the bully do? (Please circle all that apply)

Called names         threatened            stole or damaged something

shoved, kicked, or hit            teased


Where did the bully do this? (Please circle all that apply)

Playground           bathroom              hallway    cafeteria   classroom

special class        bus                   field      Somewhere else


Did this person bully you or someone else? ________________________

        If someone else, who did you witness getting bullied?

                ____________________________________

				
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posted:7/6/2011
language:English
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