* 1. First name

* 2. Current role (Example: student, mom, teacher, pastor, 6th grader, etc.)

* 3. Please share your experience of being bullied.  (Who? What? When? Where? Why?)

* 4. How did you deal with it at that time? (Example: told a teacher/parent, fought back, hid, etc.)

* 5. Have you overcome it? If so, how? (Give a few steps you took that helped you.)

* 6. How has this experience made you "better?" (Example: stronger, more compassionate, open-minded, etc.)

* 7. If you could say one encouraging thing to someone who is currently being bullied, what would it be?

* 8. Thank you! All done. In case we need to contact you, what's your best email address?

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