Darrouzett ISD

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This information will be kept confidential with your campus administrator and/or superintendent.

Website Reported Incident

May we contact you for more information on this incident?

Yes

Person reporting the incident:(OPTIONAL). Please use your full name. You must use if you said yes above.

Date of Incident:

Date of Report:

Who was the person(s) engaged in bullying?

Grade of person(s) who engaged in bullying?

Who was being bullied?

Grade of person who was being bullied?

What type of bullying?

Physical

Emotional/Social

Damage to Property

Online

Other:

Other location details: (Please explain the specific location details such as which hallway, where on the Internet, what restroom, etc)

Describe what happened with as many details as possible.

Thank you for reporting this incident. We appreciate your concern. When you click "Submit Form" this will be sent to the campus administrator.

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Report a Bully