WELCOME!

Please take our survey (answer all questions) and then at the end, you have a chance to get

SOMETHING FREE!

Be Sure To Check all boxes that apply and be totally honest! Thank you :)

E-mail Address: *
Did you ever bully anyone this school year? *
If YES, how often did you bully this person? *	one or more times a day one or more times a week one or more times a month
Where did you bully him/her? *	Homeroom Hallway Bathroom Gym Cafeteria Bus Sporting Event Online Text message Dances Before School After School Locker Other Classroom
What is the one place you bullied them the most? *	Homeroom Cafeteria Academic Classroom Before School After School Bus Gym Dances Sporting Events Bathroom Hallway Text Message Online Locker
How did you bully this person? *	Called them names Made fun of them Threatened to do bad things to them Played jokes on them Wont let them be part of my group Broke their things Attacked them Didn't talk to them Wrote bad things about them Said mean things behind their back Pushed or Shoved them Other
Who did you bully? *	Older boys Older girls Younger boys Younger girls Boys in my grade Girls in my grade Someone who is weak Someone who is an adult Someone who has no power Someone who is not popular Someone who has no friends Someone who is dumb Someone I didn't know
How much of a problem was this bullying for you? *	Made me feel sick I couldn't make friends Made me feel back or sad Made it difficult for me to learn I didn't come to school I had problems with my family I wanted to tell them I was sorry but couldn't
Why did you bully this person? Check all that are true *	Their face looks funny They act weird They're fat The church they go to They're skinny Their brother or sister or family member They look too young Their family is poor They're a wimp Their friends are weird Someone in their family has a disability They're sick a lot They are too tall They're disabled They're too short They get good grades They're in special ed They get bad grades They get angry a lot They cry a lot Because of where they live The clothes they wear They cant get along with others The color of their skin They're gay The country they're from The way they talk They're different They have acne They're ugly Other
What is the main reason you bullied this person? Choose One *	Their face looks funny Church they go to They're fat They're skinny Their sister, brother, or family Their family is poor They look too young They look too old They are a wimp Their family has a lot of money Their friends are weird They are weird They are sick a lot They are too tall They are too short They are disabled They get good grades Bad Grades Where they live The clothes they wear They cry a lot They get angry a lot They are in special ed They cant get along with other people The way they talk The country they are from They are gay They are different The color of their skin Acne Ugly
Did the teachers and school staff know about the bullying that you did? *	Yes No I don't know
How did you think your teachers and school staff took care of the bullying? *	Very well Okay Bad I don't Know
Tell us what teachers and staff did to take care of the bullying. *
Do you believe... (check all that apply) *	Most people who get bullied ask for it Bullying is a problem for kids Bullies are popular I don't like bullies I'm afraid of the bullies at my school Bullying is good for wimpy kids I would be friends with a bully Bullies hurt kids I can understand why someone would bully other kids I think bullies should be punished Bullies don't mean to hurt anybody Bullies make kids feel bad I feel sorry for kids who are bullied Being bullied is no big deal
Is bullying a problem in your school? *
Do you think that schools should worry about bullying? *
Has bullying at your school changed in the last year for you? *
What do you think has caused this change? *
Some children hit and push other children. Is this true about you? *
Some children often bully other children. Is this true for you? *
Some children often laugh at other children. Is this true about you? *
Some children often pick on other children. Is this true about you? *
Some children often tease other children. Is this true about you? *
Some children call other children horrible names. Is this true about you? *
Do you think that you can change? *
Do you want to change? *
Do you feel that you need more help to change? *
Please write what you feel you would need to help you change. *
Please write any other ideas you have about bullying and being bullied. *
Gender: *
Age: *
What language is spoken in your home? *
What country is your family from? *
Race: *	White Black/African American Latino/Hispanic Asian American Native American Middle Eastern Eastern European Asian Biracial Other
What Grade are you in? *	1 2 3 4 5 6 7 8 9 10 11 12
Where do you live--city & state? *
What school do you go to? *


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