Instructions: All questions are about your experience at the school you attend right now. Pick the answer that best matches how you feel. If your experiences at this school have changed considerably between this year and prior years (better or worse) please clarify that in your final written answer.


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* 1. My teachers treat me with respect.

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* 2. I get along well with my teachers.

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* 3. Students treat the teachers with respect.

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* 4. My teachers tell me when I am doing well.

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* 5. If I have a problem I would likely talk to my teacher about it.

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* 6. I feel safe at school.

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* 7. I feel safe on the bus or when walking to school. (choose N/A if you drive to school)

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* 8. If there is an emergency at school, I know who to go to for help.

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* 9. I trust most people in this school.

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* 10. Even students who seem different are treated well at this school.

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* 11. Adults listen to the students when we tell them about fights or bullying behavior.

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* 12. We have a lot of practice drills in order to know what to do in an emergency.

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* 13. Students take our various emergency drills seriously.

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* 14. I would be comfortable going to an administrator about a concern with another student.

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* 15. I would use the anonymous tip-line if I was aware of a threat against the school.

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* 16. There is no tolerance for dating violence or sexual harassment/assault on campus.

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* 17. Online bullying or harassment is fairly common amongst students.

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* 18. Fights on this campus are infrequent and broken up quickly.

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* 19. There is drug or alcohol use on our campus.

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* 20. When students are being picked on, other students will step in to stop it.

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* 21. I have been bullied.

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* 22. I have had my things stolen.

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* 23. I have had people treat me bad because they think I'm different.

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* 24.  I have had people treat me bad because of my race or color.

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* 25. I have been hit, punched, or kicked (on purpose).

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* 26. I have been pushed, grabbed, or shoved (not by someone who was just  playing around.)

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* 27. I have had someone threaten to hurt me.

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* 28. I have seen a student with a knife on campus.

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* 29.  I have seen a student with a gun on campus.

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* 30. I have seen people on campus who make me feel nervous.

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* 31. There are places on campus I am afraid to go alone.

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* 32.  I have seen dating violence on this campus.

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* 33. I have been sexually harassed at school.


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* 34. I have been targeted through social media with hurtful rumors or things that make me feel unsafe at school.

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* 35. I know students on this campus who have thought about killing themselves.

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* 36.  I know some students on campus who are involved with a gang.

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* 37. Please use the space to write down anything you think is important for us to know about how safe or unsafe you feel at your school. 

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