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Valley Center Intermediate Student Conflict Survey
Please take this short survey and it will be e-mailed to your principal. They will then follow-up with the student who submits the checklist.
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* Indicates required question
Victim
*
Your answer
Offender
*
Your answer
Name
*
Your answer
Where did this happen?
*
Your answer
Date
*
Your answer
It happens a lot
Yes
No
Clear selection
We're usually friends
Yes
No
Clear selection
They try to be my friend again
Yes
No
Clear selection
They are hitting or pushing
Yes
No
Clear selection
They have power over me
Yes
No
Clear selection
They are waiting on me
Yes
No
Clear selection
The other person feels bad about it
Yes
No
Clear selection
I am the only person upset
Yes
No
Clear selection
Please put down any other information that you would like the principal to know.
Your answer
Submit
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