Clow Stop, Walk, Talk Spring 2012
Please answer these questions about your life at school.
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1.  I am a *
2.  I am in *
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3.  Do you feel safe at school? *
4.   Have you been bullied at school this year? *
5.   If you have been bullied this year, how often did it happen? *
6.   If you have been bullied this year, was it by the same person or by different people? *
7.   If you have been bullied this year, how old was the bully? *
8.   If you have been bullied this year, where did it happen? *
Required
9.   Did you tell the bully to stop? *
10.   If you did say stop, did the bullying stop? *
11.   Did you walk away? *
12.   If you did walk away, did the bullying stop? *
13.   Did you talk to an adult? *
14.   If you did talk to an adult, did the bullying stop? *
15.   Do you think it is helpful to talk to an adult when you have a problem? *
16.   If you were bullied this year and did not use Stop, Walk, Talk strategies, why not? *
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