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Have You Ever Been Bullied?
(This is an anonymous survey. Names are unknown)
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A red asterisk (*) indicates required questions.
Have you ever been bullied? Please click on Yes or No.
*
Yes
No
If you answered yes, how often did someone bully you? If no, select "I have never been bullied."
*
Occasionally
Often
Every day
I have never been bullied."
If it happened at school, where? You may check more than one.
*
Hallway
Classroom
Playground
Bathroom
Cafeteria
Bus
Somewhere else
I have never been bullied.
Have you seen other students being bullied at school?
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Yes
No
If you answered yes, how often did it happen?
*
Occasionally
Often
Every day
I have never been bullied.
Where have you seen other students bullied? You may check more than one.
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Hallway
Classroom
Playground
Cafeteria
Bathroom
Bus
On the Internet
Somewhere else
What kinds of things have bullies done to you or to someone you know? You may check more than one.
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Called names
Threatened
Stole or damaged something
Shoved, kicked, or hit
Ignored
Told lies about
How much of a problem is bullying for you?
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Very much
Not much
None
List some of the actions you think parents, teachers, and other adults could perform to stop bullying. (You may type up to 60 characters.)
*
Mrs. L
Broadview Heights, OH
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