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* 1. What school  do you got to?

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* 2. What grade are you in this year?

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* 3. Please answer yes or no to the follow statements.

  Yes Maybe No
I feel safe at school.
I have lots of friends at school.
I like to come to school.
My teachers help if there is a bully.
I know what to do if I feel like I am being bullied.
Other kids have called me names at school.
My teacher tells me when I make good choices.
My teacher cares about me.
I like to learn new things at school.
I feel like I'm different from other kids.
My teachers listen to me.
My teacher tell us to respect each other.
I feel safe on the bus.
I feel safe at recess.
I show respect to my teacher by listening and following directions.
My teacher helps me learn.
When I am at school, I try my best.
Students are treated fairly by the principal.
I am a good student.
My family wants me to do well in school.

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