CAIR-FL Bullying Survey

CAIR-Florida requests your feedback. Please complete the following survey about your experience in school with discrimination.

Please note: This survey is for information gathering purposes only. If you are a victim of bullying and would like CAIR-FL’s legal assistance please contact us at 813-514-1414 or www.cairflorida.org

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(Optional) Name:

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* 1. (Optional) Name:

School Name:

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* 2. School Name:

Date:

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* 3. Date:

Religion:

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* 5. Religion:

Country of Origin/Ethnicity:

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* 6. Country of Origin/Ethnicity:

Gender:

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* 7. Gender:

Age:

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* 8. Age:

Grade:

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* 9. Grade:

State:

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* 10. State:

City:

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* 11. City:

Have you ever felt singled out or bullied? If so, was it because of your...

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* 12. Have you ever felt singled out or bullied? If so, was it because of your...

I wear the following:

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* 13. I wear the following:

My teachers and administrators are responsive to my religious needs (i.e. give me time for prayer, excuse absence for Eid, provide Halal foods, allow me to wear different P.E. uniform, etc).

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* 14. My teachers and administrators are responsive to my religious needs (i.e. give me time for prayer, excuse absence for Eid, provide Halal foods, allow me to wear different P.E. uniform, etc).

My teachers and administrators understand my disability and are responsive to it.

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* 15. My teachers and administrators understand my disability and are responsive to it.

I feel comfortable letting students know about my religion, country of origin, race or disability.

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* 16. I feel comfortable letting students know about my religion, country of origin, race or disability.

Has a student from school made offensive comments about your religion, country of origin, race or disability in school?

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* 17. Has a student from school made offensive comments about your religion, country of origin, race or disability in school?

Has a student from school made offensive comments about your religion, race, country of origin or disability through social media like Snapchat, Twitter, Facebook, Instagram, etc?

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* 18. Has a student from school made offensive comments about your religion, race, country of origin or disability through social media like Snapchat, Twitter, Facebook, Instagram, etc?

Have your teachers, coaches, administrators, safety officers or administrators made offensive comments about your religion, race, country of origin or disability?

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* 19. Have your teachers, coaches, administrators, safety officers or administrators made offensive comments about your religion, race, country of origin or disability?

Have your teachers, coaches, administrators, safety officers or administrators allowed offensive comments about your religion, race, country of origin, or disability to be made at school or in class?

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* 20. Have your teachers, coaches, administrators, safety officers or administrators allowed offensive comments about your religion, race, country of origin, or disability to be made at school or in class?

Have you seen another student picked on or singled out for their country of origin, race, religious dress or religion?

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* 21. Have you seen another student picked on or singled out for their country of origin, race, religious dress or religion?

Do you feel teachers are understanding of your religious or ethnic background?

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* 22. Do you feel teachers are understanding of your religious or ethnic background?

I am comfortable participating in class discussions about Islam or countries where Muslims live.

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* 23. I am comfortable participating in class discussions about Islam or countries where Muslims live.

Have you felt uncomfortable because the way Islam is taught in your school?

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* 24. Have you felt uncomfortable because the way Islam is taught in your school?

If you had any of these experience, how did you respond?

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* 25. If you had any of these experience, how did you respond?

What did the school do to fix the situation?

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* 26. What did the school do to fix the situation?

Comments / Testimonial: Tell us about your experience.

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* 27. Comments / Testimonial: Tell us about your experience.

Please select yes if you give us permission for us to use your story for educational purposes. Your permission allows us to share your information through our webpage, social media, or other means. 

If you are under 18, please make sure you have your parents permission.

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* 28. Please select yes if you give us permission for us to use your story for educational purposes. Your permission allows us to share your information through our webpage, social media, or other means. 

If you are under 18, please make sure you have your parents permission.

Thank you very much for taking the time to complete this survey. Your feedback is valued and very much appreciated!

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