WELCOME KIDS!

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

FREE BULLY BUSTER BUTTON! YAY!

E-mail Address: *
What Grade are you in? *	Kindergarten 1st 2nd 3rd 4th 5th 6th
What City & State do you live in? *
What School do you attend? *
What is your Home Teachers name *
Are you male or female *
What is your race? *	White/Caucasion African American Latino Mixed Other
Have you ever bullied/abused anyone? *
Have you bullied/abused someone this school year? *
Where have you bullied others? *	Online/Cyber Gym Lunch room Playground Classroom Bahtroom Bus
In what ways have you bullied others? *	Verbal Physical Emotional Sexual Cybert Text Left Them Out
Why have you bullied/abused others? *	Peer Pressure Get Friends Fear/ Hurt Yourself Power & Control Revenge
What happened as a result of you bullying/abusing others? *	Nothing Parents Called Warning Detention 3-5 day Suspension Grounded Felt Bad Apologized Kept Bullying Stopped Bullying
Have you ever been bullied/abused? *
Have you been bullied/abused this school year? *
Where have you been bullied/abused? *	Online/Cyber Lunchroom Playground Bus Gym Bathroom Off Campus
In what ways have you been bullied/abused? *	Verbal Physical Emotional Sexual Cyber Text Left Out
When you were bullied, did you...? *	Fight Back Report the Bullying Keep It a Secret Run Away Team up with a Friend/ Buddy System
What happened to the person who bullied you? *	Nothing Parents Called Warning Grounded Detention 3-5 day Suspension Expelled Apologized Still Bullying You Stopped Bullying You
What do you see as the biggest form of bullying today? *	Peer Pressure Self Abuse Cyber Verbal Physical Emotional Sexual Texting
Have you ever thought about hurting yourself or ending your life or both? *
Have you ever thought about hurting/killing others or both? *
Have you ever been afraid to go to school because of not feeling safe? *
Does you school have rules against bullying that you are aware of? *
Does your school have a Bully Buster Program? *
Would you like to be part of a Bully Buster Program if they had one? *
What is your main role in bullying? *	Bully Buster Victim Bystander Bully
How do you think having a Bully Buster peer mentor program in your school would be helpful? *
Would you like to be a Bully Buster Peer Mentor? *
Do you feel you need a Bully Buster Peer Mentor? *
Do you think it would help to have everyone in your school sign our Abuse Bites Bully Buster Pledge? *
Would you like to have us come and do our program at your school? *


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