Bullying Survey
What is your name? (optional)
First Name
Last Name
What is your gender?
Please Select
Female
Male
Transgender
Gender-neutral
Prefer not to say
What is your ethnicity?
Please Select
White or Caucasian
Hispanic or Latino
Asian or Asian American
African American
Native American or Indian
Native Hawaiian & other Pacific Islander
Native Alaskan
Other
Questionnaire
1. Do you feel safe at school?
Yes
No
2. Have you ever witnessed bullying at school?
Yes
No
3. Have you ever been teased at school?
Yes
No
4. Have you ever been threatened at school?
Yes
No
5. Have you ever been physically hurt in any way at school?
Yes
No
6. Have you ever bullied someone?
Yes
No
7. Is there violence at your home?
Yes
No
8. How often are you bullied at school?
Never
1
2
3
4
Everyday
5
1 is Never, 5 is Everyday
9. How often do you bully the others?
Never
1
2
3
4
Everyday
5
1 is Never, 5 is Everyday
10. Could you please tell how you were bullied?
I haven't been bullied
I have been kept names
I have been physically assaulted
They did not let me sit in the cafeteria at lunch
They captured my food
Nobody talks me at school because I am different
I have been threatened at school
Other
11. What would you do, if you witness bullying?
Do nothing
Call the police
Report to the school authorities
Talk about it with your friends
Tell your parents
Deal with on your own way
Other
12. Have you talked to anyone about being bullied?
I have never been bullied
No, because I am scared
Yes, I talked to my teachers
Yes, I talked to my parents
Yes, I talked to the principal
Yes, I talked to my friends
Other
13. Please indicate the places, where bullying occurs the most
Never
Sometimes
Often
Very Frequent
I don't know
Hallway
1
2
3
4
5
Restrooms
6
7
8
9
10
School Bus
11
12
13
14
15
Lunchroom
16
17
18
19
20
Gym
21
22
23
24
25
Social Media
26
27
28
29
30
14. Why do you think some students are bullies?
15. What can school authorities do to stop bullying at school?
Submit
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