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* 1. I attend: 

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* 2. My grade is:

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* 3. Are you a boy or a girl?

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* 4. I eat breakfast

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* 5. Grown-ups at my school care about kids.

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* 6. I can find a grown-up to help me when needed.

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* 7. Is there a place (or places) on campus where you feel unsafe?
You may choose more than one answer.

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* 8. What do you do if/when you feel unsafe at school?
You may choose more than one answer.

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* 9. Select the different ways that you have resolved a problem with another student. 
You may choose more than one answer.

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* 10. What would you do if you saw someone being mistreated by another student?
You may choose more than one answer.

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* 11. Which grown ups at your school follow the ACT statement the BEST? (You can write more than one name).
(use comment box)

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