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* 1. Which Year Level are you in?

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* 2. Has there been a time at school when someone has bullied you?

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* 3. Write the names of the students who have bullied you (if you have been bullied before).

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* 4. If you have been bullied, has it stopped?

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* 5. How many times do you think you have been bullied in the past week?

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* 6. How many times do you think you have been bullied in the past month?

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* 7. Where were you bullied? (If you have been bullied in the past?)

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* 8. Who do you tell if someone bullies you? (If you have been bullied)

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* 9. If you have been bullied, how would you like the school to help you?

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* 10. What can you do to make you feel safe from bullying?

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