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* 1. Campus:

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* 2. Are you male or female?

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* 3. What grade are you currently in at this school?

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* 4. What is your Race/Origin? (You may mark one or more races)

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* 5. All students are treated the same, regardless of family income.

How strongly do you agree or disagree with the following statements about this school?

In the survey, "This school" means activities happening in school buildings, on school grounds, on school buses, and at places that hold school-sponsored events or activities. Unless otherwise specified, this refers to normal school hours or to times when school activities/events were in session.

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* 6. Adults working at this school treat all students respectfully.

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* 7. Teachers and other adults are available when I need to talk with them about anything.

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* 8. Students respect one another and get along with each other.

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* 9. I feel safe at this school.

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* 10. I sometimes stay home because I don’t feel safe at this school.

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* 11. Students at this school carry guns or knives to school.

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* 12. Students at this school threaten to hurt other students.

How strongly do you agree or disagree with the following statements about this school?

This question is about bullying. Bullying happens when one or more students tease, threaten, spread rumors about, hit, shove or hurt another student. It is not bullying when students of about the same strength or power argue or fight or tease each other in a friendly way. Bullies are usually stronger, or have more friends or more money, or some other power over the student being bullied. Usually, bullying happens over and over, or the student being bullied thinks it might happen over and over.

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* 13. Students at this school are often bullied.

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* 14. Students at this school try to stop bullying.

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* 15. Students often spread mean rumors or lies about others at this school on the internet (i.e., Facebook™, email, and instant message).

Drugs means any substance, including those used to get “high” or increase performance in school or sports, other than alcohol or tobacco.  Examples include marijuana, illegal drugs, inhalants, synthetic drugs used to get high (K-2, bath salts, white lightning), or over-the-counter medicine. This does not include medications prescribed by doctor or nurse for the person, but includes prescription drugs that are NOT prescribed to the person by his/her doctor.

 “Alcohol” means a full or part of a drink of alcohol. Examples include beer, wine, mixed drink, shot of liquor, or any combination of these alcoholic drinks. This does not include alcohol that you may drink for religious purposes.

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* 16. I have used alcohol, marijuana, tobacco, or other drugs?

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* 17. Students use/try alcohol or drugs while at school or school-sponsored events.

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* 18. It is easy for students to use/try alcohol or drugs at school or school-sponsored events without getting caught.

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* 19. Students at this school think it is okay to smoke one or more packs of cigarettes a day.

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* 20. Students at this school think it is okay to get drunk.

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* 21. Students at this school think it is okay to try drugs.

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* 22. Students know what to do if there is an emergency, natural disaster (tornado, flood) or a dangerous situation (e.g. violent person on campus) during the school day.

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* 23. If students hear about a threat to school or student safety, they would report it to someone in authority.

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* 24. The things I’m learning in school are important to me.

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* 25. I have been suspended or expelled this school year.

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* 26. Adults working at this school help students develop strategies to understand and control their feelings and actions.

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* 27. Discipline is fair.

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* 28. My parents are involved in my academics and behavior and are welcomed to attend activities at school.

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