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Student Survey
All questions in this survey pertain to the this school year only.
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* Indicates required question
1. Based on the definition above, have you been bullied by someone at school this year?
Yes
No
Clear selection
2. What Grade are you in?
*
Preschool
KinderPrep
Kindergarten
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
6th Grade
3. Are you a
Boy?
Girl?
Clear selection
4. During this school year has anyone called you a name?
Yes
No
Clear selection
5. During this school year has anyone told you that you can't be friends?
Yes
No
Clear selection
6. During this school year has anyone left you out of an activity?
Yes
No
Clear selection
7. During this school year has anyone hit, kicked, or pushed you?
Yes
No
Clear selection
8. During this school year has anyone said they want to hurt you?
Yes
No
Clear selection
9. During this school year has any student forced you to do something you didn't want to do?
Yes
No
Clear selection
10. During this school year was someone mean to you because of how you look?
Yes
No
Clear selection
11. If you answered yes to any of the above, did you tell a teacher about any of the incidents?
Yes
No
I answered "No" to all of them.
Yes, but the teacher told me not to tattle.
Clear selection
12. Have you ever seen someone else being bullied?
Yes
No
Clear selection
13. Did you report the bullying behavior?
Yes
No
I have never witnessed bullying
Yes, but the teacher told me not to tattle.
Clear selection
14. Have you ever called someone a name, hit, kicked, pushed, threatened, or been mean to someone?
Yes
No
Clear selection
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