In this survey, we are interested in learning about whether you might have experienced bullying at your school. Your answers will be used in aggregate, and we will not be evaluating individual responses. As such, please be as honest as possible - there are no right or wrong answers.

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1. During the last week, how many times, if any, has someone made fun of you, called you names, or insulted you?

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2. During the last week, how many times, if any, has someone pushed you, shoved you, or tripped you?

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3. During the last week, how many times, if any, has someone spread rumours about you?

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4. During the last week, how many times, if any, has someone threatened you with harm?

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5. During the last week, how many times, if any, has someone tried to make you do things you did not want to do; for example, give them money or other things?

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6. During the last week, how many times, if any, has someone damaged or destroyed something that belongs to you on purpose?

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7. During the last week, how many times, if any, has someone left you out of or wouldn't let you join in activities on purpose?

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8. During the last week, how many times, if any, has someone used cell phones or the Internet to say or post hurtful things about you?

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9. About how many students attend your school?

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10. What are the lowest and highest classes at your school?

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11. What is the class that you are in at your school?

Thank you for participating in this survey. Your responses will give us a better understanding of bullying at schools.

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