Keystone Parent Bullying Prevention Survey
Read the following statements concerning bullying at school, and respond based on your understanding and/or direct knowledge. Please provide the appropriate personal information as well. If you have more than one child attending school, please complete more than one survey.

Bullying is when someone repeatedly and on purpose says or does mean or hurtful things to another person who has a hard time defending himself or herself. The imbalance of power may be in one or more of the following areas:
- Social Power
- Financial Power
- Physical Power
- Athletic Power
- Intellectual Power
My name is *
Your answer
My child is in *
My child is *
My child's 5 digit lunch ID is *
Your answer
In the past year, my child has reported to me that he/she has been the victim of bullying at school. *
In the past year, my child has reported to teachers or other school staff that he/she has been the victim of bullying at school. *
My child has a clear understanding of how to report bullying behavior to teachers or other school staff. *
As a parent, I have a clear understanding of the school's policies, practices and procedures related to issues of harassment and bullying. *
As a parent I have a clear understanding of the Olweus Bullying Prevention Program, as it is utilized at Keystone. *
As a parent, I believe the school has taken appropriate measures to reduce and/or eliminate bullying. *
I believe school staff have taken appropriate prevention and intervention steps related to bullying for all students. *
My child indicates that school staff intervene when they observe bullying or when bullying is reported to them. *
My child has stayed home at least one school day during the past 12 months due to the fear of being bullied at school. *
In the past year, I have reported to school officials that my child has been bullied at school. *
In the past year, my child has been bullied through the use of social media or electronic devices. *
My child has indicated that he/she has been bullied at school in the following locations. Please check all that apply *
Required
As a parent I am willing to support bullying prevention efforts by
Additional ways in which I am willing to support bullying prevention include
Your answer
Submit
Never submit passwords through Google Forms.
This form was created inside of Keystone School District. Report Abuse