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* 1. Does your school have an anti-bullying program?

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* 2. If yes, please describe the program.

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* 3. My principal or school counselor has explained the program and how to report someone being bullied?

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* 4. I know how to report to an adult that someone is being bullied.

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* 5. I know strategies to use when someone is being bullied.

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* 6. My teachers understand the strategies to use against bullying.

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* 7. I understand that there are rules about bullying and there will be consequences for being a bully.

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* 8. The anti-bullying program teaches me how to be friends with other students at school.

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* 9. The anti-bullying program teaches bullies how to peacefully solve problems.

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* 10. The anti-bullying program teaches me how to help a friend or classmate when I see they are being bullied.

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* 11. The anti-bullying program teaches me how to solve problems peacefully.

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* 12. In the past year, do you feel that there has been less bullying in the following areas?

  Strongly Agree Agree Disagree Strongly Disagree
Bus
Bus-stop
Hallways
Playground
Cafeteria
Classroom
Restroom
Cyber-based

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