The purpose of this survey is to learn more about students’ beliefs and treatment of others in your school. The questions ask about what you think and what you do. In order for this survey to be helpful, it is important that you answer each question as thoughtfully and honestly as possible. Remember, your participation is voluntary, but we want you to know that your answers are very important, and no one will be able to tie your responses to you.

This is not a test, so there are no right or wrong answers.

All of the questions should be answered by marking one of the answer spaces. If you do not find an answer that fits exactly for you, use the one that comes closest.

Your answers are important to us, so please follow these instructions carefully.

Do not put your name, identifier or any information, other than the requested response to the questions.

Complete the survey silently.

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* 1. I belong at this school

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* 2. I think this is a good school to go to.

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* 3. Students like to go to this school.

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* 4. Friendships are made at this school.

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* 5. Groups of students do not get along together in this school.

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* 6. Some students in this school do not like each other.

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* 7. The teachers care about how students feel in this school.

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* 8. The teachers go out of their way to help students.

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* 9. There are very few rules to follow.

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* 10. If a student breaks a rule in this school, they are disciplined.

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* 11. The teacher will send a student out of class if he/she does not behave.

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* 12. Since the beginning of the school year have you been physically attacked by someone your age who was trying to hurt you on purpose?

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* 13. Since the beginning of the school year has someone threaten to beat you up?

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* 14. Since the beginning of the school year has people tried to ruin your stuff on purpose, like ripping up your books?

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* 15. Since the beginning of the school year has some of your things been stolen from you at school?

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* 16. Since the beginning of the school year have you been teased in an unfriendly way?

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* 17. Since the beginning of the school have you been excluded from a group on purpose?

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* 18. Since the beginning of the school year have you been called hurtful names?

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* 19. Since the beginning of the school year have you had an unkind rumor spread about you?

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* 20. Since the beginning of the school year have you had someone your age try to use physical force or a weapon (like a gun, a knife, or another object that can hurt you) to try to get something from you?

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* 21. Since the beginning of the school year, has someone posted unkind or hurtful things about you on the Internet?

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* 22. Since the beginning of the school year, has someone called you, text your cell phone, or emailed you and said mean things?

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* 23. Since the beginning of the school year, has someone instant messaged (IM) you and said unkind of hurtful things to you?

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