Please indicate your gender

Please indicate your gender.
Male Female Other
What is your age?
11-13 14-16 17-19
Have you ever been bullied?
Yes No
How many times have you ever been bullied?
Often Sometimes Never
Where have you been bullied?
School Home Social Media
Does Bullying affect your attendance record from school?
Yes No
I’m a victim of
Physical Bullying (punching, hitting etc.)
Verbal bullying (Name calling)
Cyberbullying (Social Media)
Do you think you should;
Confront the bully and request them to stop harassing you.
Avoid the bully.
Report the bully to an adult.
In what forms are the students who bully you in?
In a lower form than you
In a higher form than you
In my form

Does bullying affect me?
Yes No Sometimes
What does the bully mainly focus on?
Racism
Appearance
Weight
Other
If you chose other for the question above , Please state.
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State how bullying affects you physically, emotionally and mentally.
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How do you feel after being bullied by someone?
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THANK YOU FOR YOUR COOPERATION

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