THE EFFECTS OF BULLYING ON THE EMOTIONAL HEALTH AMONG GRADE 10 STUDENTS

Name (Optional): Grade & Section:

Sex: Male Female Age:
DIRECTIONS: If you have experienced any of the following circumstances, put a check in the
box to the right of each sentence for each question in the survey. Your responses will not be
made public and will be kept confidential.

QUESTIONS YES NO

Does bullying cause you to have unstable mood swings?

Do you feel like you can't speak up or seek help because of

the bullying?

Does bullying make you feel lonely or isolated most of the

time in the classroom?

Do you find yourself feeling sad, hopeless, or helpless as a

result of bullying?

Do you feel anxious or fearful about going to any place

because of the bullying?