1. Do the bullies make personal comments about your facial features or make comments about your figure? Yes No
1. Do the bullies make personal comments about your facial features or make comments about your figure?
Yes No
2. Do the bullies write in your schoolbooks, steal your property, or steal your homework? Yes No
2. Do the bullies write in your schoolbooks, steal your property, or steal your homework?
3. Do the bullies tell racially or religiously biased jokes at your expense, or mock traditional ethnic clothing that you wear, or make fun of an unusual accent that you have? Yes No
3. Do the bullies tell racially or religiously biased jokes at your expense, or mock traditional ethnic clothing that you wear, or make fun of an unusual accent that you have?
4. Do the bullies leer at, whistle at, or cat call you? Yes No
4. Do the bullies leer at, whistle at, or cat call you?
5. Do the bullies jostle you with their shoulders, or push you with their hands, or shove you into others, or elbow you when passing? Yes No
5. Do the bullies jostle you with their shoulders, or push you with their hands, or shove you into others, or elbow you when passing?
6. Do the bullies call you cruel nicknames, make fun of you in front of your friends or laugh at the way you talk? Yes No
6. Do the bullies call you cruel nicknames, make fun of you in front of your friends or laugh at the way you talk?
7. Do the bullies write racially biased graffiti on walls, or tell cruel stories about members of minority group that you belong to or like to hang out with? Yes No
7. Do the bullies write racially biased graffiti on walls, or tell cruel stories about members of minority group that you belong to or like to hang out with?
8. Do the bullies introduce sexually demeaning content into their conversations with you? Yes No
8. Do the bullies introduce sexually demeaning content into their conversations with you?
9. Do the bullies kick you, punch you with their fists, scratch or bite you, or pull your hair? Yes No
9. Do the bullies kick you, punch you with their fists, scratch or bite you, or pull your hair?
10. Do the bullies exclude you from teams, clubs, or groups because you belong to a minority group? Yes No
10. Do the bullies exclude you from teams, clubs, or groups because you belong to a minority group?
11. Do the bullies threaten to attack you physically or damage your property outside of school? Yes No
11. Do the bullies threaten to attack you physically or damage your property outside of school?
12. Do the bullies threaten to embarrass you in front of your friends if you refuse to do what the bullies tell you to do? Yes No
12. Do the bullies threaten to embarrass you in front of your friends if you refuse to do what the bullies tell you to do?
13. Do the bullies physically try to "feel you-up" when you clearly want no contact with them? Yes No
13. Do the bullies physically try to "feel you-up" when you clearly want no contact with them?
14. Do the bullies spread continual rumors that you are homosexual? Yes No
14. Do the bullies spread continual rumors that you are homosexual?
15. Do the bullies damage your property, or attack you physically, or send you threatening instant messages because you belong to a minority group? Yes No
15. Do the bullies damage your property, or attack you physically, or send you threatening instant messages because you belong to a minority group?
16. Do the bullies threaten to hurt you, or steal your property, if you refuse to do what the bullies want you to do? Yes No
16. Do the bullies threaten to hurt you, or steal your property, if you refuse to do what the bullies want you to do?
17. Do the bullies continually spread rumors stating that you are a slut? Yes No
17. Do the bullies continually spread rumors stating that you are a slut?
18. Do the bullies threaten you with a weapon, lock you in dark places or physically assault members of your family or your friends? Yes No
18. Do the bullies threaten you with a weapon, lock you in dark places or physically assault members of your family or your friends?
19. Do the bullies threaten your friends with physical harm in school, on the bus, or via instant messenger because you belong to a minority group? Yes No
19. Do the bullies threaten your friends with physical harm in school, on the bus, or via instant messenger because you belong to a minority group?
20. Have the bullies inflicted lasting physical harm on you (bloody nose, open cuts, cracked ribs, split lips, cracked teeth, black eye, etc.)? Yes No
20. Have the bullies inflicted lasting physical harm on you (bloody nose, open cuts, cracked ribs, split lips, cracked teeth, black eye, etc.)?