Most of the time, this is how I feel about coming to school in the morning: *
This is how much I like the children in this class: *
In this class, I feel happy: *
In this class, I feel sad *
In this class, I feel bored *
In this class, I feel angry *
In this class, I feel lonely *
The students in this class respect me *
The students in this class respect each other *
The adults in this building care about me *
There is a at least one adult at school that I can go to for help if something is bothering me. *
Please give the name of an adult (you can list more than one) that you can go to for help if something is bothering you. If you are not sure then write"not sure". If you do not feel comfortable with any adults at school write "none". *
Your answer
How often does another child in your class say something nice to you? *
How often does another child in your class says something mean to you? *
How often does another child in your class tease you? *
How often does another child from your class exclude you or leave you out? *
How often do you say something nice to someone in your class *
How often do you say something mean to someone in your class? *
How often do you tease someone in your class? *
How often do you exclude someone or leave someone out in your class? *
How often is another child mean to you on the bus
Clear selection
How often is another child mean to you at recess *
How often does another child tell you that you can't play with them at recess. *
This is how safe I feel on the playground *
This is how safe I feel in the classroom *
This is how safe I feel in the hallways of school *
This is how safe I feel on the bus
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This is how safe I feel in the cafeteria *
Write the name of an adult at home you can talk to if you are having a problem *
Your answer
List any ideas that you think would make you feel better about coming to school.
Your answer
As you are finishing this survey, check any feelings that you have now *
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