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* 1. School District

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* 2. School Name

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* 3. Grade

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* 4. Gender

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* 5. Do you like school?

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* 6. Do you know your school Bullying Policy?

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* 7. Since beginning of year what describes you best?

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* 8. What type of of bullying have you been part of, or witnessed? Check all that apply.

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* 9. About how many times?

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* 10. How were you bullied? Check all that apply.

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* 11. Where does bullying happen? Choose all that apply.

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* 12. Who have you talked to about bullying? Choose all that apply.

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* 13. Who would you feel comfortable talking to about bullying? Choose all that apply.

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* 14. Comments about bullying:

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* 15. I feel bullying is a concern at my school.

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* 16. I feel safe at my school.

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