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TYA Elementary

Student Respect Questionnaire

We will be spending some time talking about bullying. Share what you know or have experienced with bullying by answering these questions. Please be serious and honest. Nothing you write will get anyone in trouble.

I am a*
- boy
- girl
I feel safe at school.*
- yes
- no
Kids get bullied at my school a lot.*
- yes
- no
I have been picked on by another student.*
- yes
- no
I will tell my teacher if someone is mean to me.*
- yes
- no
Telling an adult when someone is mean:*
- helps
- does not help
I can be mean to another student:*
- never
- sometimes
- a lot
Kids get picked on in:*
- the hall
- the classroom
- lunch
- the bathroom
- the bus
If someone is mean to me, I:*
- tell someone
- am mean back
- ignore it
- stay away from the person
If I see someone being bullied, I:*
- don’t know what to do
- tell a grownup
- say something to stop it

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