Welcome Parents!

Please take a few minutes to fill out our survey (answer all questions, if they don't apply put N/A in the box). The results will better help us to stop bullying and offer the help and healing that is needed. Also let us know if you think of a question or topic that needs to be addressed. Thank you for your time and cooperation in this urgent matter!

Together we can Change Hearts & Save Lives!

E-mail Address: *
What School Does Your child attend? *
What City & State do you live in? *
Sex? *
Race? *	White/Caucasion African American Latino Mixed Other
Sexual Orientation?	Heterosexual Homosexual / Gay Lesbian Bi-Sexual
Has there been a problem with bullying at your childs school? *
In what ways has your child been bullied/abused? *	Verbal Physical Emotional Sexual Cyber Text
In what ways has your child bullied/abused others? *	Verbal Physical Emotional Sexual Cyber Text
Has your child ever said they couldnt take it anymore or they wanted to die? If yes, what actions if any were taken... *
Has your child ever threatened another child? If so what actions if any were taken... *
What do you think is the biggest reason kids are bullying? *	No Policy/Rules at School Enforced Peer Pressure to Get Friends Theyre victims and afraid of being bullied Power & Control Bad Home Life
What have you as a parent tried to teach your child? *	Walk Away Fight Back Keep Quiet Buddy System Report it
In the past what is the biggest way youve seen your child reacting to bullies? *	Walk Away Fight Back Report Bullying Keep Quiet Buddy System
Have you noticed a difference in your childs behavior since we presented our program? *
In what ways? *	Less Bullying Same More Bullying More Reports Less Fighting More Fighting More kids Sticking Together Talking More Talking Less Worse Grades Better Grades More Depressed Less Depressed
What was your childs favorite part of our program? *	Dogs/ Trick Presentation Power Point/ Stories Games / Student Participation
What was your favorite part of our program?
Does your school have an anti-bullying peer mentor group/program like our Bully Buster program? *
If no, do you hope they use our Bully Buster Program in the future?
Does your childs school have an anti-bullying policy in effect as well as an action plan? *	Yes No
Do you think your child would benefit from having our Bully Buster program in their school?
In what ways?
What was the best thing you learned that you didnt already know and helps you as a parent? *
How do you feel that our program is unique and stands out from all the other anti-bullying programs? *
Any thoughts on how we can make our program better? *
Overall how would you rate our program? *	1 (being the worst) 2 3 4 5 6 7 8 9 10 (being the best)
Have you ever been bullied or abused? *
In what ways and how did you handle it? *
Have you bullied or abused others? *
In what ways and how did they handle it? *


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