Please complete each of the questions.

* 1. Which school do you attend?

* 2. What is your grade level?

* 3. Please tell us how you feel about each of these statements.

  Strongly Agree Agree Disagree Strongly Disagree Does not apply to me
I feel safe at school.
I feel safe during recess.
I feel safe outside of class before and after school.
I feel safe in the restrooms.
I feel safe in the cafeteria.
I feel safe at the bus stop.
I feel safe riding the bus.
I feel safe walking to school.
I feel safe while attending the after-school program.
I feel comfortable reporting problems to my teacher.
I feel comfortable reporting problems to my principal.
The adults treat students with respect.
Students treat other students with respect and care.
I know the school's rules.
I feel that the school's rules are fairly applied.
The school is kept neat and clean.
The office is a safe place to get help.

* 4. What do you like best about your school?

* 5. How could your school be improved?

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