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* 1.

Which school do you attend?

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* 2.

What grade are you in currently?

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* 3. I get bullied at school by being pushed, kicked or hit:

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* 4. I get bullied at school by name-calling, put-downs, teasing, or being left out.

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* 5. I bully others at school.

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* 6. I think that most of the bullying that happens at our school happens:

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* 7. I get bullied on my way to and from school.

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* 8. When I am in school, I worry about being bullied.

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* 9. If someone bullies me, I usually

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* 10. If I see someone else getting bullied, I usually

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* 11. To help me feel safe at our school, I think adults should

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* 12. I have been bullied electronically (phone, text, email, site).

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* 13. I have bullied someone electronically (phone, text, email, site)

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