1. Default Section

Question Title

* 1. Grade:

Question Title

* 2. Homeroom Teacher:

Question Title

* 3. Boy or Girl?

Question Title

* 4. Name (Optional):

Question Title

* 5. How much do you like school?

Question Title

* 6. How many good friends do you have in your classes?

Question Title

* 7. How many times since school started this year have you been called mean names, teased or made fun of in a hurtful way?

Question Title

* 8. How many times since school started this year have you been purposefully completely left out of activities with classmates?

Question Title

* 9. How many times since school started this year have you been hit, kicked, shoved around, or physically hurt on purpose?

Question Title

* 10. How many times since school started this year have you actually known that other students told lies about you, spread false rumors about you, or intentionally tried to make others dislike you?

Question Title

* 11. How many times since school started this year have you had items belonging to you taken away or damaged on purpose in order to show meanness to you?

Question Title

* 12. How many times since school started this year have you been forced by other students to do things you did not want to do?

Question Title

* 13. How many times since school started this year have people acted mean to you or made hurtful statements because of your race, color, or ethnicity?

Question Title

* 14. How many times since school started this year have you known people to use mean names, or make rude comments, or use obscene gestures with a sexual meaning?

Question Title

* 15. Since school started this year, when classmates treated you meanly, where did this take place?

Question Title

* 16. Since school started this year, when people were being mean to you at school, who did you tell about it?

Question Title

* 17. Since school started this year, how often do teachers and other adults at school try to stop students from being mean to each other when they know about it?

Question Title

* 18. Since school started this year, how often do students try to stop other students from being mean to others when they know about it?

Question Title

* 19. When you see a student your age being treated in a mean way, what do you think?

Question Title

* 20. Since school started this year how often have you taken part in actions to be mean to another student?

Question Title

* 21. Since school started how often have you called a classmate names, or made fun of or teased him or her in a hurtful way?

Question Title

* 22. Since school started how often have your purposefully excluded or left anyone out of activities?

Question Title

* 23. Since school started how often have you hit, kicked, pushed, or shoved someone around just to be mean to him or her?

Question Title

* 24. Since school started this year how often have you spread gossip, rumors, and tried to cause classmates to dislike a classmate?

Question Title

* 25. Since school started this year how often have you taken something or damaged something of someone else in order to be mean to them and cause them to have hurt feelings?

Question Title

* 26. Since school started this year, how often have you forced a classmate to do something he or she did not want to do?

Question Title

* 27. Since school started this year how often have you called someone mean names in connection with his/her color, race, ethnicity?

Question Title

* 28. Since school started this year, how often have you called someone mean names or made comments or used gestures that have a sexual meaning?

Question Title

* 29. Since school started this year, has any teacher talked with you individually about being mean to other students?

Question Title

* 30. Since school started , has any adult at home talked with you individually about being mean to other students?

Question Title

* 31. Do you think you might join others in being mean to someone you do not like?

Question Title

* 32. Since school started this year, how have you reacted when you have seen a student your age bing mean to one of your classmates?

Question Title

* 33. Since school started this year, how often have you been afraid of classmates being mean to you?

Question Title

* 34. In all, how much do you think your classroom teachers have really tried to stop students from being mean to other students when they know it is happening?

T