Definitions of Terms:

"Harassment, Intimidation, or Bullying" means any intentional written, verbal, graphic, or physical act that a student or group of students exhibited toward another particular student more than once and the behavior both:

a.     causes mental or physical harm to the other students; and

b.     is sufficiently severe, persistent, or pervasive that is creates an intimidating, threatening, or abusive educational environment for the other student.

“Harassment, Intimidating, or Bullying” also means electronically transmitted acts i.e., Internet, cell phone, personal digital assistance (PDA), or wireless hand-held device that a student has exhibited toward another particular student more than once and the behavior both:

a.     causes mental or physical harm to the other student/school personnel; and

b.     is sufficiently severe, persistent, or pervasive that it creates an intimidating, threatening, or abusive educational environment for the other student.

Survey Items:

                        (responses)               NEVER              SOMETIMES                  OFTEN

                                                                                   Several times / month       Several times / week

1.    Usually, I feel safe while at school.

2.    During the school year, about how many times did you feel bullied or harassed by other students?

3.   During the school year,On the busabout how many times did you feel bullied or harassed by other students?

4.   During the school year, I have been threatened or intimidated by others.

5.   During the school year, I have been excluded or left out on purpose.

6.   During the school year, I have been talked about on the Internet or phone in a hurtful way.

7.   During the school year, I have threatened or intimidated others.

8.   During the school year, I have excluded or left out someone on purpose.

9.   During the school year, I have talked about others in a hurtful way on the Internet or phone.

10. When students break rules at my school, they are treated fairly.

11.  I feel like I belong to my school.

12.  My school is important to me.

13. During the school year, teachers and staff at my school are doing the right things to prevent bullying.

14. During the school year, I told lies or made fun of some students using the Internet (e-mail, instant messaging, cell phone text messaging, or websites).

15.  During the school year, I stood by and watched other students getting hit, pushed, shoved, or tripped.

16.   In your opinion, bullying is…

a.    Physical Aggression

b.   Mental Abuse

c.    Emotional Harassment

d.   Other…

17.If I feel that I have been bullied, I know a school staff member to talk to.

a.    Yes

b.    No

18.Where do you see students being bullied at this school?

a.    Hallways

b.    Cafeteria

c.     Classroom

d.    Bus

e.    Outside (social time)

19.This school year I am in the …

a.    6^thGrade

b.    7^thGrade

c.     8^thGrade