Bullying Survey

1. Are you a boy or a girl?
  *This question is required.

• Boy
• Girl

2. What grade are you in?  *This question is required.

• 6th
• 7th
• 8th

3. Last year in school someone bullied me by...doing things like hitting, kicking, punching or throwing things.

1= never 2=sometimes 3=about once a week 4=more than once a week *This question is required.

1	2	3	4
1	2	3	4

4. Last year in school someone bullied me by...hurting me with a weapon like a stick, ruler, knife or something else. *This question is required.

1	2	3	4
1	2	3	4

5. Last year in school someone bullied me by...threatening to hurt me.

1= never 2=sometimes 3=about once a week 4=more than once a week *This question is required.

1	2	3	4
1	2	3	4

6. Last year in school someone bullied me by...saying things about my body or saying sexual things that made me feel uncomfortable, embarassed or afraid.

1= never 2=sometimes 3=about once a week 4=more than once a week

*This question is required.

1	2	3	4
1	2	3	4

7. Last year in school someone bullied me by...touching my body or my clothes in an in appropriate way

1= never 2=sometimes 3=about once a week 4=more than once a week

*This question is required.

1	2	3	4
1	2	3	4

8. Last year in school someone bullied me by...making me give them money or other things

1= never 2=sometimes 3=about once a week 4=more than once a week

*This question is required.

1	2	3	4
1	2	3	4

9. Last year in school someone bullied me by...making me do what they told me when I didn’t want to.

1= never 2=sometimes 3=about once a week 4=more than once a week

*This question is required.

1	2	3	4
1	2	3	4

10.  
Last year in school someone bullied me by…saying hurtful things about my skin color, the country I came from, or my religion.

  *This question is required.

1	2	3	4
1	2	3	4

11. Last year in school someone bullied me by…spreading untrue stories and gossip about me
  *This question is required.

1	2	3	4
1	2	3	4

12. Last year someone sent me a hurtful, untrue e-mail or text message.
  *This question is required.

1	2	3	4
1	2	3	4

13. Last year someone posted a hurtful, untrue message about me in an Internet chat room *This question is required.

1	2	3	4
1	2	3	4

14. This section asks if you have bullied someone else.
1 = never   2 = sometimes   3 = about once a week   4 = more than once a week

I have bullied someone by hitting kicking, punching or throwing things *This question is required.

1	2	3	4
1	2	3	4

15. This section asks if you have bullied someone else.
1 = never   2 = sometimes   3 = about once a week   4 = more than once a week

I have bullied someone by saying things about their body or saying sexual things that made them feel uncomfortable *This question is required.

1	2	3	4
1	2	3	4

16. This section asks if you have bullied someone else.
1 = never   2 = sometimes   3 = about once a week   4 = more than once a week

I have bullied someone by touching their body or their clothes

*This question is required.

1	2	3	4
1	2	3	4

17. This section asks if you have bullied someone else.
1 = never   2 = sometimes   3 = about once a week   4 = more than once a week

I made them give me money or other things. *This question is required.

1	2	3	4
1	2	3	4

18. This section asks if you have bullied someone else.
1 = never   2 = sometimes   3 = about once a week   4 = more than once a week

Called them hurtful name

1	2	3	4
1	2	3	4

19. This section asks if you have bullied someone else.
1 = never   2 = sometimes   3 = about once a week   4 = more than once a week

Spread untrue stories and gossip about them *This question is required.

1	2	3	4
1	2	3	4

20. This section asks if you have bullied someone else.
1 = never   2 = sometimes   3 = about once a week   4 = more than once a week

Tried to make others not be their friend and leave them out of things

1	2	3	4
1	2	3	4

21. This section asks if you have bullied someone else.
1 = never   2 = sometimes   3 = about once a week   4 = more than once a week

Sent them a hurtful, untrue e-mail or text message *This question is required.

• 1
• 2
• 3
• 4

22. This section asks if you have bullied someone else.
1 = never   2 = sometimes   3 = about once a week   4 = more than once a week

Posted a hurtful, untrue message about them in an Internet Chat room or other social media page *This question is required.

1	2	3	4
1	2	3	4

23. This section asks if you have bullied someone else.
1 = never   2 = sometimes   3 = about once a week   4 = more than once a week

Made fun of someone because of their skin color *This question is required.

1	2	3	4
1	2	3	4

24. This section asks if you have bullied someone else.
1 = never   2 = sometimes   3 = about once a week   4 = more than once a week

Called someone gay, lesbian or made fun of them because for acting gay *This question is required.

1	2	3	4
1	2	3	4

25. Have you watched someone or heard about someone being bullied? Please circle the correct response.
  *This question is required.

• Yes
• No

26. If yes, why didn’t you do anything?
  *This question is required.

1. Fear of retaliation from other students	2. Did not think it would make a difference	3. Didn’t want the bully to come after you.	4. Told someone, but nothing happened.	5. Told someone and the bullying stopped	6. I have not watched or heard about someone being bullied before	Took a stand against bullying by saying or helping the person being bullied, and the bullying stopped.
1. Fear of retaliation from other students	2. Did not think it would make a difference	3. Didn’t want the bully to come after you.	4. Told someone, but nothing happened.	5. Told someone and the bullying stopped	6. I have not watched or heard about someone being bullied before	Took a stand against bullying by saying or helping the person being bullied, and the bullying stopped.

27. If you saw someone being bullied in school or online, what would you do?

• Stand up and say something to the buly
• Say something nice about the person being gossiped about or change the subject.
• Post a nice message and not go along with the cyberbully.
• Just stand by as th e bullying happens in front of you and do nothing.