Middle School Climate Survey
Please choose the school you attend. *
Please indicate your grade.
Please indicate your race.
Are you Hispanic/Latino?
Please indicate your gender.
1. I regularly participate in extra-curricular activities offered through this school such as school clubs or organizations, musical groups, sports teams, student governments, dances, sporting events or any other extra-curricular activities.
Students at this school are teased or picked on about...
A. Strongly Agree
B. Agree
C. Neither Agree Nor Disagree
D. Disagree
E. Strongly Disagree
2 ...their race or ethnicity.
3 ...their cultural background or religion.
4 ...their physical or mental disability.
Students at my school...
A. Strongly Agree
B. Agree
C. Neither Agree Nor Disagree
D. Disagree
E. Strongly Disagree
5...carry guns or knives to school.
6 ...belong to gangs.
7 ...threaten to hurt other students.
8 ...steal money, electronics, or other valuable things while at school.
9 ...damage or destroy other students' property.
10 ...damage or destroy school property.
11 ...fight a lot.
12 ...are sometimes physically hurt by their boyfriends or girlfriends while at school.
During this school year, how many times has someone from your school...
A. Almost every day
B. Once or twice a week
C. Once or twice a month
D. Once or twice this school year
E. Never
13 ...made fun of you, called you names or insulted you?
14 ...spread rumors about you?
15...threatened to hurt you?
16 ...pushed you, shoved you, tripped you or spit on you?
17 ...tried to make you do things you did not want to do, for example, give them money?
18 ...excluded you from activities on purpose?
19 ...destroyed your property on purpose?
20 ...posted hurtful information about you on the Internet, threatened or insulted you online (direct messaging, text messaging, online gaming, instagram, snapchat, etc.)?
21 ...bullied you in any way?
I think that...
A. Strongly Agree
B. Agree
C. Neither Agree Nor Disagree
D. Disagree
E. Strongly Disagree
22 ...if another person was bullying me, I would report it to an adult at this school.
23 ...if I told an adult at this school that I was being bullied, the adult would do something to help.
24. Have you told anyone that you have been bullied during this school year?
25. How often do the teachers or other adults at school try to put a stop to it when a student is being bullied at school?
If you have been bullied this school year, did you report it to...
No
Yes
26 ...your classroom or homeroom teacher?
27 ...another adult at school?
28 ...your parent(s)/guardians(s)?
29 ...your brother(s) or sister(s)?
30 ...your friend(s)?
31 ...somebody else?
32. Have you ever hurt yourself on purpose?
33. Have you ever seriously considered committing suicide?
During the past 30 days...
Yes
No
34 ...did you drink one or more alcoholic beverages?
35 ...did you smoke part or all of a cigarette?
36 ...have you used marijuana?
37 ...have you used prescription drugs not prescribed to you or misused prescription drugs that were prescribed to you?
How much do you think people risk harming themselves physically or in other ways if they....
A. No Risk
B. Slight Risk
C. Moderate Risk
D. Great Risk
38 ...have 5 or more alcoholic beverages (beer, wine, liquor) once or twice a week?
39 ...have one or two alcoholic beverages (beer, wine, liquor) nearly every day?
40 ....smoke one or more packs of cigarettes per day?
41 ...smoke marijuana once or twice a week?
42 ...use prescription drugs that are not prescribed to them or misuse prescription drugs that were prescribed to them?
How wrong do your parents think it would be for you to...
A. Not at all Wrong
B. A Little Bit Wrong
C. Wrong
D. Very Wrong
43 ...have one or two alcoholic beverages nearly every day?
44 ...smoke tobacco?
45 ...smoke marijuana?
46 ...use prescription drugs not prescribed to you or misuse prescription drugs that were prescribed to you?
How wrong do your friends think it would be for you to...
A. Not at all Wrong
B. A Little Bit Wrong
C. Wrong
D. Very Wrong
47 ...have one or two alcoholic beverages nearly every day?
48...smoke tobacco?
49 ...smoke marijuana?
50 ...use prescription drugs not prescribed to you or misuse prescription drugs that were prescribed to you?
51. How do you USUALLY get alcohol if you consumed alcohol in the past 30 days?
52. How do you USUALLY get tobacco if you used tobacco in the past 30 days?
53. How do you USUALLY get prescription drugs (not prescribed to you) if you used prescription drugs (not prescribed to you) in the past 30 days?
Have you ever tried...
No
Yes
54 ...cigarettes or other tobacco products?
55 ...alcohol?
56 ...marijuana?
57 ...prescription drugs (not prescribed to you)?
58 ...Vapes or E-cigarettes?
59. I know what to do if there is an emergency, natural disaster (ex. tornado, flood) or a dangerous situation (ex. violent person on campus) during the school day.
60. If I hear about a threat to school or student safety, I would report it to someone in authority.
I think that...
A. Strongly Agree
B. Agree
C. Neither Agree Nor Disagree
D. Disagree
E. Strongly Disagree
61 ...I will definitely graduate from high school.
62 ...I plan to continue my education after high school.
63. I am happy to be at this school.
Please tell us if there is anything else about your school experience that you would like to share with us. Please enter your response in the space provided.
Your answer
Thank you for your time and help in improving your school!
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