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Bullying Prevention Program Questionnaire
This survey is about bullying. Completing this survey honestly will help the Family Resource Center understand bullying behavior in our community and schools. It will also help us to develop a course of action to reduce the affects has on Limestone County residents as a whole.
Date of Birth
Your answer
Are you a Limestone County Resident?
Have you ever been physically, verbally, or indirectly bullied?
How many times have you been physically bullied in the last month?
How many times have you seen someone physically bullied in the last month?
How many times have you been verbally bullied in the last month?
How many times have you seen someone else verbally bullied in the last month?
How many times have you been indirectly bullied in the last month?
How many times have you seen someone else indirectly bullied in the last month?
How many times have you been cyber bullied in the last month?
How many times have you seen someone else cyber bullied in the last month?
If you are a student please check all locations you have been physically or verbally bullied in the last month.
If you are not a student please check the places where you have been physically or verbally bullied.
Has anyone (teachers, administrators, family members, etc.) ever taken the time to discuss what to do if you see bullying, ways to avoid bullying, or any other issues concerning bullying?
Does your school or housing administration have rules against bullying students/residents?
What is your gender?
Please choose appropriate response.
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