SURVEY ON CYBERBULLYING EXPERIENCES AMONG SENIOR HIGH SCHOOL

STUDENTS: IMPACT ON THEIR SOCIO-EMOTIONAL HEALTH ADAPTED

FROM SANTOS’ (2020) SURVEY ON THE PREVALANCE OF
CYBERBULLYING AMONG STUDENTS

I. Demographic Profile

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Name (Optional):
Gender: Male
Female

Grade Level: 11 12
II. Cyberbullying
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4- Frequently experienced
3- Experienced
2- Almost never
1-Never experienced
4 3 2 1
(FE) (E) (AN) (NE)
1. Embarrassing you through text message,
e-mails, or chats
2. Humiliating you through text message,
e-mails, or chats
3. Impersonating online to make you look bad
or to destroy your reputation
4. Receiving hateful, malicious, derogatory and/or
cruel/mean joke and information
5 Spreading rumors or gossip
5. Lies online or by means of electronic
or social media
6. Threatening or intimidating
you online
III. Socio-emotional Effects of Cyberbullying

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4- Strongly Agree
3- Agree
2- Disagree
1-Strongly Disagree

Statements Strongly Agree Disagree Strongly

Agree (3) (2) Disagree
(4) (1)

1. I feel anxious every time others teased

me for being gay/lesbian.
2. I lose confidence when I am in front of
people.
3. I skip school to get away from the
people who bully me.
4. I have thoughts of committing suicide
to escape from bullying
5. I feel unsafe in our school.
6. I cannot show my true feelings because
they do not listen to me.
7. I find it hard to establish relationships
with peers.
8. I feel I do not belong
in our class.
9. I cannot join to our school
activities