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Bullying Survey

Dear Student,

If you would please take time to fill out this short survey, your honesty in answering would be much appreciated by many.

1 During the last week, how many times, if any, has someone made fun of you, called you names, or insulted you?
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2 During the last week, how many times, if any, has someone spread rumors about you?
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3 During the last week, how many times, if any, has someone pushed you, shoved you, tripped you, or spit on you?
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4 During the last week, how many times, if any, has someone threatened you with physical harm?
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5 During the last week, how many times, if any, has someone tried to make you do things you did not want to do, for example, give them money?
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6 During the last week, how many times, if any, has someone destroyed your property on purpose?
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7 During the last week, how many times, if any, has someone left you out of or wouldn’t let you join in activities on purpose?
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8 During the last week, how many times, if any, has someone used a telephone, text message or the Internet to say or post hurtful things about you?
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9 Around how many students attend your school?
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250 characters remaining

10 What are the lowest and highest year groups taught at your school?
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1500 characters remaining