Bullying Survey
Please answer the following questions as honestly as possible.
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1. Has anyone ever repeatedly called you a name? *
2. Has anyone ever repeatedly told you that you can’t be friends without cause? *
3. Has anyone ever hit, kicked or pushed you? *
4. Has anyone ever threatened you? *
5. Was someone or a group of people repeatedly mean to you because of how you look? *
6. Have you ever been excluded from a party or event that everyone else was invited to for an unexplained reason? *
7. Have you ever been sent a mean message via email, text message, SMS, or posting on a social media sight (example: Facebook)? *
8. Did you tell anyone about any of these incidents? Why or why not? *
9. Have you ever seen someone else being bullied? *
10. Have you ever repeatedly called someone else a name, hit, kicked, pushed, threatened or been mean to someone? *
What grade are you in? *
Are you a boy or a girl? *
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