SCHOOL:____________________ DATE:_________□ MALE I □ FEMALE
_______________________________________________________________
Agree Disagree
SCHOOL:____________________ DATE:_________ □ MALE I □ FEMALE
_______________________________________________________________
Agree Disagree
cornerSTONE
cornerSTONE
BEFORE WE START TALKING
Harassment
_____
20. I told an adult about the harassment I experienced.
_____
19. I have been harassed because of my religion.
_____
18. I have been harassed because of my actions or reputation.
(strong, weak, smart, dumb, big mouth, quiet)
_____
17. I have been harassed because of sexual orientation.
(being called gay, lesbian, bi-sexual, etc..)
_____
16. I have been harassed because of my ethnicity.
(skin color,culture)
_____
15. I have been harassed because of my gender.(boy,girl)
_____
14. I have been harassed because of my choice of friends/group.
(popular, skater, nerd, hip-hop, punk, sport)
_____
13. I have been harassed because of my appearance
(weight, height, style, looks, body type)
_____
12. I have been harassed non-verbally.(gestures,stares,cyber)
_____
11. I have been verbally harassed at school.(jokes,name-calling)
_____
10. I have been sexually harassed at school.(touched,comments)
_____
9. I have been physically harassed at school.(hit, pushed,tripped)
_____
8. If someone is harassed and doesn’t say anything, it must
Not bother them.
_____
7. Many students don’t report harassment because they
think it won’t help.
_____
6. A lot of students/teachers overreact about harassment.
_____
5. If you see someone being harassed you should keep
your distance. After all, it’s none of your business.
_____
_____
4. I have seen people being harassed at my school.
_____
3. I know someone who’s been Cyber Bullied (email, txt, Facebook )_____
_____
_____
2. Some people just ask to be harassed.
(For example:certain clothing, reputation, smart off a lot)
_____
1. Sometimes I’m not sure what harassment is.
_____
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BEFORE WE START TALKING
BEFORE WE START TALKING
1. Sometimes I’m not sure what harassment is.
2. Some people just ask to be harassed.
(For example:certain clothing, reputation, smart off a lot)
Harassment
_____
_____
3. I know someone who’s been Cyber Bullied (email, txt, Facebook )_____
4. I have seen people being harassed at my school.
5. If you see someone being harassed you should keep
your distance. After all, it’s none of your business.
6. A lot of students/teachers overreact about harassment.
7. Many students don’t report harassment because they
think it won’t help.
8. If someone is harassed and doesn’t say anything, it must
Not bother them.
9. I have been physically harassed at school.(hit, pushed,tripped)
10. I have been sexually harassed at school.(touched,comments)
11. I have been verbally harassed at school.(jokes,name-calling)
12. I have been harassed non-verbally.(gestures,stares, cyber)
13. I have been harassed because of my appearance
(weight, height, style, looks, body type)
14. I have been harassed because of my choice of friends/group.
(popular, skater, nerd, hip-hop, punk, sport)
15. I have been harassed because of my gender.(boy,girl)
16. I have been harassed because of my ethnicity.
(skin color,culture)
17. I have been harassed because of sexual orientation.
(being called gay, lesbian, bi-sexual, etc..)
18. I have been harassed because of my actions or reputation.
(strong, weak, smart, dumb, big mouth, quiet)
19. I have been harassed because of my religion.
20. I told an adult about the harassment I experienced.
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BEFORE WE START TALKING
cornerSTONE
AFTER WE’RE DONE TALKING
Harassment
cornerSTONE
AFTER WE’RE DONE TALKING
Harassment
1. Because I was a part of this presentation–
I can identify a time when I witnessed or
experienced bullying or harassment.
Circle one→
YES
NO
1. Because I was a part of this presentation–
I can identify a time when I witnessed or
experienced bullying or harassment.
Circle one→
YES
NO
2. Because I was a part of this presentation–
I am able to better recognize bullying and harassing
behaviors.
Circle one→
YES
NO
2. Because I was a part of this presentation–
I am able to better recognize bullying and harassing
behaviors.
Circle one→
YES
NO
3. Because I was a part of this presentation–
I feel more informed and able to help myself or
someone dealing with bullying and harassment.
Circle one→
YES
NO
3. Because I was a part of this presentation–
I feel more informed and able to help myself or
someone dealing with bullying and harassment.
Circle one→
YES
NO
4. If I were in need of help or had questions about
bullying or harassment Cornerstone staff would be a
resource I would use.
Circle one→
YES
NO
4. If I were in need of help or had questions about
bullying or harassment Cornerstone staff would be a
resource I would use.
Circle one→
YES
NO
5. Because I was a part of this presentation–
I will not bully or harass others.
Circle one→
YES
NO
5. Because I was a part of this presentation–
I will not bully or harass others.
Circle one→
YES
NO
6. I would like to talk with someone from Cornerstone
6. I would like to talk with someone from Cornerstone
about a situation:
Name:_____________________Contact:__________________
about a situation:
Name:_____________________Contact:__________________
Add me as friend on Myspace, Facebook, Twitter.
Contact info online:____________________________
Add me as friend on Myspace, Facebook, Twitter.
Contact info online:____________________________
Any Comments?
Any Comments?
AFTER WE’RE DONE TALKING
AFTER WE’RE DONE TALKING