Sex: Male Female    Race or Ethnicity: White Non-Hispanic African-American Non-Hispanic Native American or Alaskan Native Hispanic Asian or Pacific Islander Other
Which campus are you enrolled on?: Elementary Junior High High School
What grade are you in? 1 2 3 4 5 6 7 8 9 10 11 12

How safe do your feel at school? Not Safe Slightly Safe Safe Very Safe
Are there particular places at school where you don't feel safe? (Select all that apply.):
Classrooms   Lunchrooms   Playground   Parking Lot   Restrooms
Are there particular times at school where your child doesn't feel safe? (Select all that apply.)
Before school   During class   During Lunch   After School   All Day

This school year have you had any of your possessions stolen at school? No Yes
This school year has anything been taken from you by force, or threats? No Yes
This school year has someone physically threatened, attacked, or hurt you? No Yes Many
This school year has someone verbally threatened you? No Yes 1+
This school year has someone made sexual advances or attempted sexual assault? No Yes 1+
This school year has someone sexually assaulted you? No Yes 1+
If yes to any of the above group, where did this happen? (Select all that apply.)
At School   To/From School   School Bus   School Activity   Other

Do you feel there is a process in place for students to report alleged abuse? Yes No
Do you feel the administrators follow up on the reports of alleged abuse? Yes No

This school year did you see someone at school with a weapon? No Yes
If yes, please specify what kind of weapon you saw. (Select all that apply.)
Gun   Knife   Scissors   Other

How serious are the following problems on campus?
Vandalism Don't Know Not Serious Serious Very Serious    Alcohol Don't Know Not Serious Serious Very Serious    Tobacco Don't Know Not Serious Serious Very Serious
Drugs Don't Know Not Serious Serious Very Serious    Weapons Don't Know Not Serious Serious Very Serious    Racial Issues Don't Know Not Serious Serious Very Serious

In your opinion, what are the three major problems at this campus right now?