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* 1. Violating School

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* 2. Site of Violation

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* 3. Date of Violation

Date

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* 4. Description of Violation

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* 5. Has violation been reported to school personnel of home site?

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* 6. Reporter Name

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* 7. Reporter Email

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* 8. Reporter Phone Number

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* 9. If you have any photo evidence of violation, please upload here:

(File size limit is 16 MB)

PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only.
Choose File

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* 10. Role of Reporter

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