1. During the last week, how many times, if any, has someone made fun of you, called you names, or insulted you?

2. During the last week, how many times, if any, has someone spread rumors about you?

3. During the last week, how many times, if any, has someone pushed you, shoved you, tripped you, or spit on you?

4. During the last week, how many times, if any, has someone threatened you with harm?

5. During the last week, how many times, if any, has someone tried to make you do things you did not want to do; for example, give them money or other things?

6. During the last week, how many times, if any, has someone destroyed your property on purpose?

7. During the last week, how many times, if any, has someone left you out of or wouldn't let you join in activities on purpose?

8. During the last week, how many times, if any, has someone used cell phones or the Internet to say or post hurtful things about you?

9. About how many students attend your school?

10. What are the lowest and highest grades taught at your school?

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