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* 1. What grade are you in?

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* 2. My peers make fun of me

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* 3. I make fun of others

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* 4. I have been physically harmed by a peer

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* 5. I have physically harmed a peer

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* 6. Sometimes I feel left out due to my race/gender/background

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* 7. I have been rude to someone based on their race/gender/background

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* 8. People call me names

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* 9. I call people names

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* 10. Someone has said rude things to or about me via text or internet

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* 11. I have said rude things to or about someone via text or internet

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* 12. I feel safe around my peers at school

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* 13. I feel comfortable telling a teacher or adult when I am bullied by someone

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* 14. I have avoided school due to feeling unsafe around my peers

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* 15. I have stood by and watched others get bullied and did not try and stop it

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* 16. I have stepped in and stopped others from bullying

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