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1. Are you male or female?

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2. How old are you? (Select one)

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3. What city and province/state do you currently live in?

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4. What kind of school do you attend?

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5. About how many students attend your school?

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6. How big a problem is bullying and how big a problem is cyberbullying? (1 is not a problem at all and 5 is a big problem.)

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7. During the last year, how many times, if any, has someone made fun of you, called you names, or insulted you using a cell phone or digital media? (insert "0" if it hasn't happened to you within the last year.)

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8. During the last year, how many times, if any, has someone spread rumors about you online? (Use "0" if it has not happened to you within the last year.)

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9. During the last week, how many times, if any, has someone threatened you with harm?

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10. During the last year, how many times, if any, has someone tried to force you do things you did not want to do; for example, send them a suggestive image, bully or cyberbully someone else or other things you didn't want to do? (Use "0" if it has not happened to you within the last year.)

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11. During the last year, how many times, if any, has someone stolen or hacked your online accounts, game items, deleted your contacts, content or communications or hacked your computer on purpose? (Use "0" if it has not happened to you within the last year.)

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12. During the last year, how many times, if any, has someone locked you out of a game or prevented you from joining or banned you from an online group or game on purpose? (Use "0" if it has not happened to you within the last year.)

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13. During the last year, how many times, if any, has someone pretended to be you online, sent mean things to your friends posing as you or by using your account, cellphone or gaming device? (Use "0" if it has not happened to you within the last year.)

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14. How many times over the last year, if any, have you been bullied in real life using any of the methods described above? (Use "0" if it has not happened to you within the last year.)

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15. How many times over the last year, if any, has someone threatened you with harm using the Internet, social media or a cellphone? (Use "0" if it has not happened to you within the last year.)

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16. How many times over the last year, if any, has someone told you to kill yourself or told you that you should die (or similar things)? (Use "0" if it has not happened to you within the last year.)

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17. How many times in the last year, if any, has someone made a hate site, page, account or community about you? (Use "0" if it has not happened to you within the last year.)

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18. Have you done any of these things to others over the last year? If so, how many times? (Use "0" if you have not done any of these things to someone else within the last year.)

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19. What is the most important thing adults don't understand about cyberbullying?

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20. Do you think we can stop all or most cyberbullying?

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21. Are you willing to help stop cyberbullying? If so, tell us what you could do to help. (Enter "no" if you are not willing to help stop cyberbullying, or tell us what you would do to help if you are willing to help.)

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22. Is there anything you want us to know that we haven't asked?

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