6th Grade Bully/Harrassment Fall 2015 Survey
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1. In the last 7 days, how many times have you been bullied at school in the ways listed: I was called names, was made fun of, or teased in a hurtful way? *
 2. In the last 7 days, how many times have you been bullied at school in the ways listed: I was pushed, shoved, tripped, hit, or spit on? *
 3. In the last 7 days, how many times have you been bullied at school in the ways listed: Someone has threatened me with harm? *
 4. In the last 7 days, how many times have you been bullied at school in the ways listed: Other students told lies, spread false rumors about me, and tried to make others dislike me? *
 5. In the last 7 days, how many times have you been bullied at school in the ways listed: I was made fun of because of my race, color, or religion? *
 6. In the last 7 days, how many times have you been bullied at school in the ways listed: Someone has excluded me, left me out, or would not let me join an activity on purpose? *
7. In the last 7 days, how many times have you been bullied at school in the ways listed: Other students made sexual jokes, comments, or gestures that hurt my feelings? *
8. In the last 7 days, how many times have you been bullied at school in the ways listed: I received a threatening or hurtful message from another student in an email, on a website, on a cell phone, from a text message, in an Internet chat room, or through instant messaging? *
9. When a student is being bullied at school, how often do the teachers or other adults at school try to put a stop to it? *
10. If bullying has occurred in the past 7 days, where did it occur? *
Click any of the areas below if you have seen bullying/harassment occur in that area.
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This form was created inside of Carlisle Community School District.