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1. Please select your child's school:

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2. Please select your child's grade level:

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3. Please give the current city or town you live in:

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4. Please select your appropriate ethnicity:

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5. My child's identified gender is:

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6. My child likes to come to school each day:

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7. I feel the students in this school are kind:

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8. I feel that this school is physically safe:

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9. I feel comfortable sharing my thoughts and ideas at this school:

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10. I feel my child's peers treat him/her fairly:

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11. I feel the adults in my child's school treat me fairly:

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12. I feel there are trusted adults in the school who my child can go to/talk to for help:

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13. When my child rides the bus, the trip to and from school is a positive/safe experience:

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14. My child is involved in extra-curricular activities such as athletics, clubs, activities, school committees,  musical/play, volunteering, employment etc.:

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15. My child has been the target of hurtful communications through technology (i.e. social media, online posts, texting etc.):

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16. My child has participated in hurtful communications through technology (i.e. social media, online posts, texting etc.):

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17. Do you feel that there is an area of the school that is not safe? If yes, where?

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18. How often do you communicate, other than reporting absences and dismissals, (in person, phone calls, emails, etc.) with your child's school during the year?

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19. In my child's school, there are clear rules against intentionally harming other people (for example, hitting, pushing, or tripping):

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20. I have seen students at my child's school being physically hurt by other students more than once (for example, pushed, slapped, punched):

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21. There are students in the school who intentionally exclude others and make them feel bad for not being a part of the group:

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22. Students at my child's school will try to stop students from insulting or making fun of other students:

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23. Students in my child's school respect each other's differences (for example, gender, race, culture, disability, sexual orientation, learning differences, etc.):

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24. Families feel welcome at my child's school:

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25. One more thing I would like to say:

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