Act Now! Staff Training Student Bullying Survey (updated) This survey should take approximately 10 minutes to complete. Participation is voluntary, meaning you can stop taking the survey at any time and can skip any questions you do not feel comfortable answering. Your answers will remain anonymous, meaning we will not ask for your name or any information that can identify who you are. OK Question Title * 1. What grade are you in? 3rd grade 4th grade 5th grade 6th grade 7th grade 8th grade OK Question Title * 2. What is your gender? Boy Girl OK Question Title * 3. How many times have you been bullied in the past couple of months? (Pick your best answer.) I have not been bullied Once or twice 2-3 times per month About once a week Several times a week OK Question Title * 4. If you have been bullied, in what ways were you bullied? (Pick all of the answers that are true for you.) Verbal bullying (name-calling) Exclusion (being left out, ignored) Physical (hit, hurt, punched, pushed, etc.) Rumors (made up stories about you to ruin your reputation or embarrass you) Damage to your things (property, school supplies, books, clothes destroyed or wrecked) Threats Racial comments or names Sexual harassment Cyberbullying (online, on Facebook, by cell phone) Another way OK Question Title * 5. If you have been bullied during the past couple of months at school, where has the bullying occurred? (Pick all of the answers that are true for you.) On the playground/school yard (during recess or breaks) In hallways/stairwells In class (with a teacher in the room) In class (when a teacher is not in the room) In the bathroom In gym class or locker room/shower In the lunchroom On the way to and from school At the school bus stop On the school bus Somewhere else at school OK Question Title * 6. How often have you taken part in bullying another student(s) at school in the past couple of months? (Pick your best answer.) I have never bullied another student. Once or twice 2-3 times per month About once a week Several times a week OK Question Title * 7. How often do the teachers or other adults at school try to put a stop to bullying when a student is being bullied? (Pick your best answer.) Every time they see bullying Most of the time Often Sometimes Almost never They never do anything to stop it OK Question Title * 8. How often do other students try to put a stop to it when a student is being bullied at school? (Pick your best answer.) Every time they see something Most of the time Often Sometimes Almost never They never do anything to stop it OK Question Title * 9. If you have been bullied during the past couple of months at school, did you tell anyone what happened? (Pick your best answer.) No, I didn't tell anyone Yes, I told a friend/classmate Yes, I told a teacher Yes, I told the principal, counselor, nurse or another adult at school Yes, I told an adult at home (parent, grandparent, aunt, uncle, or guardian) Yes, I told another adult or person not listed here OK DONE