BULLYING SURVEY

CHS Elementary & Middle Students


A red asterisk (*) indicates required questions.

  1. Please choose your grade level.*
    4
    5
    6
    7
    8


  1. Gender*
    Boy
    Girl


  1. How do you like your school?*
    I dislike my school very much.
    I dislike my school.
    I neither like nor dislike my school.
    I like my school.
    I like my school very much.


  1. How many friends do you have at school?*
    None
    1
    2 or 3
    4 or 5
    6 or more


  1. How often have you been bullied at school this school year (2011-2012)?*
    0
    1 or 2 times
    3 or 4 times
    5 or 6 times
    6 or more times


  1. How many times this school year were you called mean names, made fun of, or teased (2011-2012)?*
    0
    1 or 2 times
    3 or 4 times
    5 or 6 times
    6 or more times


  1. This school year (2011-2012), I was physically hit, kicked, or pushed by a bully?*
    0
    1 or 2 times
    3 or 4 times
    5 or 6 times
    6 or more times


  1. Other students have spread lies and false rumors about me this school year (2011-2012).*
    0
    1 or 2 times
    3 or 4 times
    5 or 6 times
    6 or more times


  1. Have you been bullied through emails, texts, Facebook, or any of type of social media this school year (2011-2012)?*
    0
    1 or 2 times
    3 or 4 times
    5 or 6 times
    6 or more times


  1. How often do the teachers at Catholic High School try to stop bullying?*
    Almost never
    Once in a while
    Sometimes
    Often
    Almost always


  1. How often do other students try to stop bullying?*
    Almost never
    Once in a while
    Sometimes
    Often
    Almost always


  1. How many times this school year (2011-2012) have you bullied another student?*
    0 times
    1 or 2 times
    3 or 4 times
    5 or 6 times
    6 or more times


  1. How often has your school, Catholic High School, discussed and addressed the subject of bullying this school year (2011-2012)?*
    0 times
    1 or 2 times
    3 or 4 times
    5 or 6 times
    6 or more times


  1. What locations on the school's campus have you been bullied or you have seen someone else being bullied this school year (2011-2012)? CHECK ALL THAT APPLY*
    Playground
    Pe Locker Room
    Bathroom
    Class room
    Hallway
    Cafeteria


  1. How often have you been afraid of being bullied this school year (2011-2012)?*
    0 times
    1 or 2 times
    3 or 4 times
    5 or 6 times
    6 or more times