Survey

Name (Optional):____________________________ Grade & Section: __________________

What is your Gender?

( ) Female ( ) Male ( ) Lesbian ( ) Gay

What is your Sexual Orientation?

( ) Heterosexual ( ) Bisexual ( ) Transsexual ( ) Homosexual

What is your Age? ____________ Status: ( ) Single ( ) Married

Did you experience being bullied? ( ) Yes ( ) No

How do you feel when youve got bullied? Explain why.

( ) Sad ( ) Angry ( ) Other Answer Please Specify

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How many times youve got bully? Answer:

What are the effects to you when someone bullies you? Explain.

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What is your common action when they bully you? Explain.

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What is your greatest motivation for being a gay? Explain.

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