Classroom Teacher Name: _________________________________________________

What is your personal definition of bullying? ___________________________________

________________________________________________________________________
________________________________________________________________________
Do you believe that bullying is a problem at Grand Haven High School?

Yes or No

Do you believe that cyber bullying is a problem at Grand Haven High School? Yes or No
Have you ever been a victim of bullying? If so, when was the last time you were bullied?
________________________________________________________________________
________________________________________________________________________
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Have you ever seen a bullying incident? If so, please explain: ______________________
________________________________________________________________________
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Is there an adult at this school that you would feel comfortable confiding in if you were a
victim of bullying?
Yes
or
No
What do you picture when you hear the phrase students with disabilities? ___________
________________________________________________________________________
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What is your experience with students with disabilities? (i.e. are you involved with links?
Do you see them around school? Do you have no experience?)_____________________
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How often do you use the word retarded to describe something per day? ____________
Do you know someone who makes fun of students with disabilities? ________________
If so, what do they say? ____________________________________________________
Do you think that students with disabilities are included in school activities, such as
lunch, classes, or larger activities such as homecoming?
Yes
or
No
Do you think that bullying of students with disabilities is a problem at Grand Haven High
School?
Yes
or
No
Any other comments about these topics: ______________________________________
________________________________________________________________________
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