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1. Teacher number (3-digit code)

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2. Rules for student behavior are enforced fairly and consistently.

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3. Most everyone at our school shares a common understanding of the word “respect”.

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4. Most everyone at our school shows respect to one another.

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5. Parents and other community members get involved in activities at our school.

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6. I see bullying occur on this campus....

  Every day Almost weekly A few times a month Rarely Never
In the cafeteria at lunch
In the classroom or lab
In the hallways between classes
In the morning before school
On the bus
Other

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7. I have been bullied on this campus....

  Every day Almost weekly A few times a month Rarely Never
In the cafeteria at lunch
In the classroom or lab
In the hallways between classes
In the morning before school
On the bus
Other

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8. Bullying on this campus is most likely to occur:

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9. Which campus do you attend?

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10. What is your grade level?

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11. What is your gender?

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12. What is your race?

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13. Write any other comments here:

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