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Peer Nomination Survey
Bullying is defined as the use of one’s strength or popularity to injure, threaten, or embarrass another person. Bullying can be physical, verbal, or social; it is not bullying when two students of about the same strength argue or fight.
- Bullying is aggressive behavior that involves unwanted negative actions
- Bullying involves a pattern of behavior repeated over time
- Bullying involves an imbalance of power or strength
Bias Based Bullying - When one person treats another person in a negative way because they either have a characteristic or are perceived to have a characteristic that falls into one of these categories:
- Creed – also known as a person’s beliefs
- Sexual orientation
- Ability or disability
- Gender
- Gender identity or gender expression
- Race
- Religion
- Political beliefs or social affiliation
- Country of National Origin or Ethnicity
- Body Weight, Shape or Size

Using these definitions, complete the survey below.

1. Using the definitions of bullying above, have you been bullied since the beginning of this school year?
2. Using the definition of bullying above, who have you seen BEING bullied since the start of the school year? (list first and last name(s) and grade level, or leave blank if you have not seen anyone)
Your answer
3. Using the definition of bullying above, who have you seen DOING the bullying since the start of this school year? (list first and last name(s) and grade level, or leave blank if you have not seen anyone)
Your answer
If you have witnessed any forms of bias-based bullying, please identify what types of bias based bullying you have witnessed. I have witnessed bias-based bullying based on: (please check all that apply).
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