Have you been harassed? Survey

Fill out the survey as honestly as possible. The survey is anonymous. (Adapted from a survey done by AAUW Educational Foundation, 1993)

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1. Have any of the following things happened to you at school when you did not want them to?

	Never	Rarely	Occassionally	Regularly
I have been the target of sexual comments, jokes, teasing, gestures, or looks.	*Have any of the following things happened to you at school when you did not want them to? I have been the target of sexual comments, jokes, teasing, gestures, or looks. Never	I have been the target of sexual comments, jokes, teasing, gestures, or looks. Rarely	I have been the target of sexual comments, jokes, teasing, gestures, or looks. Occassionally	I have been the target of sexual comments, jokes, teasing, gestures, or looks. Regularly
I have received intimidating/inappropriate messages through email/internet sites.	I have received intimidating/inappropriate messages through email/internet sites. Never	I have received intimidating/inappropriate messages through email/internet sites. Rarely	I have received intimidating/inappropriate messages through email/internet sites. Occassionally	I have received intimidating/inappropriate messages through email/internet sites. Regularly
I have had rumors spread about me.	I have had rumors spread about me. Never	I have had rumors spread about me. Rarely	I have had rumors spread about me. Occassionally	I have had rumors spread about me. Regularly
I have been touched, grabbed, or pinched in a way that made me feel uncomfortable.	I have been touched, grabbed, or pinched in a way that made me feel uncomfortable. Never	I have been touched, grabbed, or pinched in a way that made me feel uncomfortable. Rarely	I have been touched, grabbed, or pinched in a way that made me feel uncomfortable. Occassionally	I have been touched, grabbed, or pinched in a way that made me feel uncomfortable. Regularly
I have been shown or given sexual pictures, photographs, illustrations, messages, or notes.	I have been shown or given sexual pictures, photographs, illustrations, messages, or notes. Never	I have been shown or given sexual pictures, photographs, illustrations, messages, or notes. Rarely	I have been shown or given sexual pictures, photographs, illustrations, messages, or notes. Occassionally	I have been shown or given sexual pictures, photographs, illustrations, messages, or notes. Regularly
I have been physically intimidated by another student.	I have been physically intimidated by another student. Never	I have been physically intimidated by another student. Rarely	I have been physically intimidated by another student. Occassionally	I have been physically intimidated by another student. Regularly
I have stayed home or cut class because I felt intimidated.	I have stayed home or cut class because I felt intimidated. Never	I have stayed home or cut class because I felt intimidated. Rarely	I have stayed home or cut class because I felt intimidated. Occassionally	I have stayed home or cut class because I felt intimidated. Regularly
I have felt unsafe at school.	I have felt unsafe at school. Never	I have felt unsafe at school. Rarely	I have felt unsafe at school. Occassionally	I have felt unsafe at school. Regularly
I have been penalized, threatened, or further harassed as a result of complaining about or reporting harassment.	I have been penalized, threatened, or further harassed as a result of complaining about or reporting harassment. Never	I have been penalized, threatened, or further harassed as a result of complaining about or reporting harassment. Rarely	I have been penalized, threatened, or further harassed as a result of complaining about or reporting harassment. Occassionally	I have been penalized, threatened, or further harassed as a result of complaining about or reporting harassment. Regularly

2. Where did the incident(s) take place? You may check all that apply.

Where did the incident(s) take place? You may check all that apply. In the hallway/stairwell

In a classroom

At the bus terminal

In or near the gym/playing field/pool

In the dining hall

At a field trip location

In the parking lot

In or near the locker room

In the restroom

In or near the dorm

On the internet/cell phone

On the school transportation on the way to school/on the way home/on a field trip

On public transportation (TheBus) on the way to school or on the way home

3. When did the incident(s) take place? You may check all that apply.

When did the incident(s) take place? You may check all that apply. Before school

Between classes

In class

During lunch

During recess

After school

Have you been harassed?
Exit this survey

1. Instructions

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1. Have any of the following things happened to you at school when you did not want them to?

2. Where did the incident(s) take place? You may check all that apply.

3. When did the incident(s) take place? You may check all that apply.

Have you been harassed?Exit this survey

1. Instructions

*1. Have any of the following things happened to you at school when you did not want them to?

2. Where did the incident(s) take place? You may check all that apply.

3. When did the incident(s) take place? You may check all that apply.

Have you been harassed?
Exit this survey

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1. Have any of the following things happened to you at school when you did not want them to?