EmailMeForm
Bullying Survey
Please answer all questions honestly. Totally anonymous.
During the last week, how many times has someone made fun of you, called you names, or insulted you?
*
0
1 - 5
5+
During the last week, how many times has someone spread rumors about you?
*
0
1 - 5
5+
During the last week, how many times has someone pushed you, shoved you, tripped you, or spit on you?
*
0
1 - 5
5+
During the last week, how many times has someone threatened you with harm?
*
0
1 - 5
5+
During the last week, how many times has someone tried to make you do things you did not want to do; for example, give them money or other things?
*
0
1 - 5
5+
During the last week, how many times has someone destroyed your property on purpose?
*
0
1 - 5
5+
During the last week, how many times has someone left you out of or wouldn't let you join in activities on purpose?
*
0
1 - 5
5+
During the last week, how many times has someone used cell phones or the Internet to say or post hurtful things about you?
*
0
1 - 5
5+
About your school
About how many students attend your school?
*
What are the lowest and highest grades taught at your school?
*
Lowest grade
Highest grade
