Think about the following statements about your school and decide whether you think they are mostly true or mostly false for you.

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* 1. I belong at this school.

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* 2. I think this is a good school to go to.

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* 3. Students like to go to this school.

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* 4. Friendships are made at this school.

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* 5. Groups of students do not get along together in this school.

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* 6. Some students in this school do not like each other.

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* 7. The teachers care about how students feel in this school.

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* 8. The teachers go out of their way to help students.

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* 9. There are very few rules to follow.

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* 10. If a student breaks a rule in this school, they are disciplined.

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* 11. The teacher will send a student out of class if he/she does not behave.

Since the beginning of the school year, have you:

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* 12. Been physically attacked by someone your age who was trying to hurt you on purpose?

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* 13. Had someone threaten to beat you up?

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* 14. Had people try to ruin your stuff on purpose, like ripping up your books?

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* 15. Had some of your things stolen from you at school?

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* 16. Been teased in an unfriendly way?

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* 17. Been excluded from a group on purpose?

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* 18. Been called hurtful names?

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* 19. Had an unkind rumor spread about you?

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* 20. Had someone your age try to use physical force or a weapon (like a gun, a knife, or another object that can hurt you) to try to get something from you?

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* 21. Had someone post unkind or hurtful things about you on the Internet?

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* 22. Had someone call you, text your cell phone, or email you and say mean things?

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* 23. Had someone instant message (IM) you and say unkind or hurtful things to you?

Think about the person who did these things to you the most.

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* 24. Was it:

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* 25. Were they:

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* 26. Were they mostly:

Since the beginning of the school year, did you STAY AWAY from any of the following places because you thought someone from school might hurt you or treat you badly there?

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* 27. The shortest route to school.

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* 28. The entrance into the school

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* 29. Any hallways in school.

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* 30. Parts of the school cafeteria.

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* 31. Any school bathrooms.

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* 32. Other places inside the school.

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* 33. The school parking lot.

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* 34. The school bus.

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* 35. Other places on school property.

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* 36. Extracurricular activities or after-school activities at school.

Since the beginning of the school year, did you:

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* 37. AVOID any classes because you thought someone might hurt you or treat you badly there?

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* 38. Stay home from school because you thought someone might hurt you or treat you badly there?

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* 39. On a scale of 1 to 10 (10 being Very Safe, and 1 being Not Safe at All), how safe do you feel at school?

Think about other students your age at school. Since the beginning of the school year, have any of the following things happened to THEM:

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* 40. Been physically attacked by someone their age who was trying to hurt them on purpose?

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* 41. Had someone threaten to beat them up?

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* 42. Had people try to ruin their stuff on purpose, like ripping up their books?

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* 43. Had some of their things stolen from them at school?

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* 44. Been teased in an unfriendly way?

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* 45. Been excluded from a group on purpose?

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* 46. Been called hurtful names?

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* 47. Had an unkind rumor spread about them?

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* 48. Had someone your age try to use physical force or a weapon (like a gun, a knife, or another object that can hurt you) to try to get something from them?

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* 49. Had someone post unkind or hurtful things about them on the Internet?

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* 50. Had someone call them, text their cell phone, or email them and say mean things?

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* 51. Had someone instant message (IM) them and say unkind or hurtful things to them?

Since the begining of the school year, have YOU done any of the following things to someone your age at school?

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* 52. Hit someone else your age.

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* 53. Made fun of someone else in an unfriendly way

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* 54. Told other students your age that they should fight.

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* 55. Spread an unkind story or rumor about someone.

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* 56. Physically hurt someone on purpose.

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* 57. Called someone your age a bad or mean name to their face.

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* 58. Told other students that you were going to hurt or hit them.

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* 59. Intentionally damaged or ruined things that belonged to another student.

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* 60. Taken or tried to take something from another student.

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* 61. Carried an object that could be used to hurt someone, like a gun, a knife, or another weapon.

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* 62. Posted unkind or hurtful things about someone on the Internet.

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* 63. Called, texted, or emailed someone and said mean things to them.

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* 64. Sent someone an instant message (IM) that said hurtful things.

Think about other students your age at school. Since the beginning of the school year, have THEY done any of the following things?

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* 65. Hit someone else your age.

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* 66. Made fun of someone else in an unfriendly way.

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* 67. Told other students their age that they should fight.

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* 68. Spread an unkind story or rumor about someone.

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* 69. Physically hurt someone on purpose, by pushing, shoving, hitting, or kicking them.

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* 70. Called someone their age a bad or mean name to their face.

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* 71. Told other students that they were going to hurt or hit them.

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* 72. Intentionally damaged or ruined things that belong to another student.

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* 73. Taken or tried to take something from another student.

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* 74. Carried an object that could be used to hurt someone, like a gun, a knife, or another weapon.

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* 75. Posted unkind or hurtful things about someone on the Internet.

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* 76. Called, texted, or emailed someone and said mean things to them.

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* 77. Sent someone an instant message (IM) that said hurtful things.

How wrong is it for someone your age to do each of the following things?

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* 78. Intentionally hurt or ruin property that belongs to someone else.

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* 79. Hurt someone or tell someone that you will hurt them without any reasons.

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* 80. Intentionally take something that belongs to someone else.

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* 81. If you knew someone being treated badly by other students at school (such as being teased, punched, tripped, made fun of, or hurt), who would you tell:
(Check all that apply)

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* 82. If you saw a weapon (like a gun, knife, or another object that can hurt someone) who would you tell:
(Check all that apply)

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* 83. In the last 3 months, do you know if any students have brought a weapon (like a gun, a knife, or another object that can hurt someone) to your school?

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* 84. In the last 3 months, have you actually seen another student with a weapon on school grounds?

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* 85. Have you ever felt bullied at school?

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* 86. Are you a:

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* 87. How old are you?

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* 88. What grade are you in?

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* 89. How would you best describe yourself?

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* 90. What grades do you earn in school?

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* 91. While you were at school, have you seen or heard information about how students at this school are expected to treat each other?

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* 92. If YES to the previous question, where do you recall seeing or hearing this information?
(Check all that apply)

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* 93. In the last month, how often do you recall seeing or hearing these messages about how studens at this school treat each other?

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* 94. I feel I can earn Renaissance each marking period.

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* 95. I put forth my best effort in school so I can make Renaissance.

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* 96. I like to be rewarded for earning good grades, good behavior, and good attendance.

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