ISD/Campus (required)
1. Sex	Male  Female
2. Race or Ethnicity	White, non-Hispanic  African-American, non-Hispanic Native American or Alaskan Native  Hispanic Asian or Pacific Islander Other
3. Grade in School	5th  6th  7th  8th  9th  10th  11th  12th
4. How safe do you feel at school?:	very safe  safe  unsafe
5a. Are there particular places at school where you don't feel safe?  If so, where are they? (Select all that apply.):	classrooms lunchroom  playground  parking lot restrooms  school bus  other
5b. Are there certain times of day when these places are unsafe? (Select all that apply.)	Before school  During class  During lunch After school Entire school day  Other
6. This school year, have you had something stolen from your desk, locker, or other place at school?:	never  one or two times  three to four times more than four times
7. This school year, has someone taken money or things directly from you by using force, weapons or threats?:	never one or two times three to four times more than four times
8. This school year, has someone physically threatened, attacked, or hurt you at school?	never  one or two times three to four times  more than four times
9a. This school year, has someone verbally threatened you at school?	never  one or two times three to four times  more than four times
9b. If yes, please specify where this happened to you: (Select all that apply.)	at school  to and from school on a school bus at a school-sponsored activity  other
10a. This school year, has someone made sexual advances or attempted to sexually assault you at school?	never  one or two times three to four times more than four times
10b. This school year, has someone sexually assaulted you at school?	never  one or two times three to four times  more than four times
11a. Is there a process in place for students to report alleged physical, psychological, or sexual abuse?	Yes   No
11b. Does the campus follow-up on reports of alleged abuse?	Yes  No
12a. Have you ever seen a student carrying a weapon at school?	Yes  No
12b. If yes, please specify what kind of weapon you saw. (Select all that apply.)	gun  knife   box opener  other
13. During this school year, how many fights have you witnessed at your school?	none  one to two  three to five  more than five
14. How often have you been bullied during your years at this school?	never  once in a while  frequently  daily
15. How often have you seen other being bullied at this school?	never  once in a while  frequently  daily
16. When you or someone else was being bullied, what did the bullies do? (Select all that apply.)	teased  insulted  threatened  played practical jokes stole or damaged belongings  shoved, kicked or physically attacked
17. Why do you think you or others have been bullied?  (Select all that apply.)	because of physical characteristics because of race or religion because of a physical handicap or learning disability
18. How well do teachers and administrators at this school handle bullying?	well  adequately  poorly the teachers and administrators don't know what's going on with kids and bullying
19. What more can teachers and administrators do to help stop bullying? (Select all that apply.)	supervise the playground and halls better establish rules against bullying enforce rules against bullying and punish bullies teach kids how to get along better
20a. Have you, without the permission of your parent(s) or guardian(s), consumed any alcoholic beverages to include beer, wine, or liquor in the past 12 months?	Yes  No
20b. If yes, how much?	1-2 times  3-4 times  5-6 times  more than 6 times
21a. Have you used any illegal drugs or medications not prescribed by a doctor or approved by your parent(s) or guardian(s) for your use, to include marijuana, cocaine, crack, ecstasy, hallucinogens,  or heroine in the past 12 months?	Yes  No
21b. If yes, how much?	1-2 times  3-4 times  5-6 times  more than 6 times
22a.Have you used any inhalants to include freon, ether, spray paint, whiteout, fingernail polish, glue, hairspray, or any other type of chemical that produces vapors that are mood altering in the past 12 months?	Yes  No
22b. If yes, how much?	1-2 times  3-4 times  5-6 times  more than 6 times
23. In your opinion, how serious are the following problems at school: Vandalism	don't know  no problem  small problem  serious problem
Gangs	don't know  no problem  small problem  serious problem
Alcohol Use	don't know  no problem  small problem  serious problem
Tobacco Use	don't know  no problem  small problem   serious problem
Drug Use	don't know  no problem  small problem   serious problem
Drug Selling	don't know  no problem  small problem   serious problem
Carrying Weapons	don't know  no problem  small problem   serious problem
Racial Conflict	don't know  no problem  small problem   serious problem
Other
24. In your opinion, what are the three major problems at school right now?
25. Please indicate the earliest age you have used any of the following substances by checking the appropriate age box. (If you have not used any of these substances then do not check any boxes) Substance/Age 9 10 11 12 13 14 15 16 17 Alcohol Marijuana Tobacco Steroids Rohypnol Downers Uppers Hallucinogens Crack/Cocaine
Thank you for completing the survey.