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Anti-Bullying Survey
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Q1: During the last week, how many times, if any, has someone made fun of you, called you names, or insulted you?
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Q2: During the last week, how many times, if any, has someone spread rumors about you?
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Q3: During the last week, how many times, if any, has someone pushed you, shoved you, tripped you, or spit on you?
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Q4: During the last week, how many times, if any, has someone threatened you with harm?
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Q5: During the last week, how many times, if any, has someone tried to make you do things you did not want to do; for example, give them money or other things?
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Q6: During the last week, how many times, if any, has someone destroyed your property on purpose?
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Q7: During the last week, how many times, if any, has someone left you out of or wouldn't let you join in activities on purpose?
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Q8: During the last week, how many times, if any, has someone used cell phones or the Internet to say or post hurtful things about you?
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Q9: About how many students attend your school?
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Your answer
Q10: How concerned are you about bullying at this school?
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Extremely concerned
Very concerned
Moderately concerned
Slightly concerned
Not at all concerned
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