In my classroom I feel...

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* 1. In my classroom I feel...

On the playground I feel...

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* 2. On the playground I feel...

In the cafeteria I feel...

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* 3. In the cafeteria I feel...

In the restrooms I feel...

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* 4. In the restrooms I feel...

Other kids hit, kick, or push me...

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* 5. Other kids hit, kick, or push me...

Other kids say mean things to me...

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* 6. Other kids say mean things to me...

Other kids steal or destroy my property...

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* 7. Other kids steal or destroy my property...

This year, who has bullied you, said mean things to you, teased you, called you names, or tried to hurt you at school?

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* 8. This year, who has bullied you, said mean things to you, teased you, called you names, or tried to hurt you at school?

In what grade is the student or students who bully you?

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* 9. In what grade is the student or students who bully you?

If you have been bullied this year, who have you told?

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* 10. If you have been bullied this year, who have you told?

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