1. What grade is your child in?
2. Is your child male or female?
3. Pick one answer for each of the following questions:
Does your child feel safe at school?
Does your child feel safe on the way to and from school?
Does your child feel safe in your neighborhood?
4. During the past four weeks…
Has your child been bullied?
Has your child stayed away from school to avoid being bullied?
Has your child, on his/her own or as part of a group, bullied other students?
5. The next questions asks about where and how often bullying occurs in and near your child’s school.
6. To your knowledge, has your child stayed away from certain classrooms or areas of the school to avoid being bullied
7. If your child is bullied, when are they most at risk?
8. How often do adults at your child’s school do the following...
9. Do the adults at your child’s school contact you if your child...
10. Are the rules related to conduct and behavior fairly enforced at the school?
11. Is there anything else that you want to tell us about safety at your child’s school?
