Have you seen bullying?

If you are under 19 and have ever seen bullying? If so, we want to hear from you! Your opinions are important! Responses are confidential. Go here if you have every been bullied. * Required Field

1. If you have ever seen bullying, we want to hear from you!

2. Which best describes your current education. *

Kalmiopsis Elementary School
Azalea Middle School
Brookings-Harbor High School
Brookings-Harbor Christian School
Homeschool
Other (please specify)

3. Does your school have a bullying prevention program?

Yes
No 

4. Are you a? *

Boy
Girl 

5. What grade are you in? *

6. Where did the bullying occur? (check all that apply)

Hallway
Classroom
Locker room
Cafeteria
Bathroom
Bus
Cell phone
Internet

7. What kind of bullying have you seen? (check all that apply)

Name calling
Threats
Tease or making fun of
Gossiped, talking behind back
Something damaged or stolen
Shoved, kicked, slapped or hit
Ignored
Left out on purpose
Calling someone “gay”
Calling someone a “retard”

8. Was the bullying about any of the following? (check all that apply)

Academic ability
Age
Clothing
Disability
Family income
Gender/sexual orientation
Hair
Height
Race
Religion
Sports Ability
Weight
Where they live 

9. What did you do in response? (check all that apply)

Joined in, bullied too
Nothing. It's not my problem
Wanted to do something but afraid to get involved
Felt bad for other person, but didn't do anything
Laughed along with everyone else
Told the person bullying to stop
Let an adult know what was happening
Helped the person being bullied
Talked with parents about it
Talked with a friend about what happened

10. Would you have liked to have done more?

Yes
No 

11. What would help you to address bullying? (check all that apply)

More information about what you do in bullying situations
Bullying policies posted at school
Support from other students
Education for kids who bully, how they can do handle situations differently
Support from adults

12. Anything else you want to share?

 

13. Your zip code? *

Optional information, not required. It will be kept confidential:

Your Name

Your eMail

Anti-Spam * Type in this field

* Required Field

Send it

 ©2013, Gordon Clay