Various Demographic Pretesting Activities

Version A
ASK OF ALL PEOPLE AGES 12-18	FORM SCS-1 U.S. DEPARTMENT OF COMMERCE Economics and Statistics Administration U.S. Census Bureau ACTING AS COLLECTING AGENCY FOR THE BUREAU OF JUSTICE STATISTICS U.S. DEPARTMENT OF JUSTICE SCHOOL CRIME SUPPLEMENT TO THE NATIONAL CRIME VICTIMIZATION SURVEY 2011 QUESTIONNAIRE
We estimate that it will take from 5 to 15 minutes to complete this interview with 10 minutes being the average time. If you have any comments regarding these estimates or any other aspect of this survey, send them to the Associate Director for Finance and Administration, Room 2027, U.S. Census Bureau, Washington DC 20233, or to the Office of Information and Regulatory Affairs, Office of Management and Budget, Washington, DC 20503. According to the Paperwork Reduction Act of 1995, no such persons are required to respond to a collection of information unless such collection displays a valid OMB control number.
Control number PSU Segment/Suffix Sample Designation/Suffix Serial/Suffx HH No. Spinoff Indicator

A. FR Code 001 

B. Respondent Line No. Age Name 002  003 

	FIELD REPRESENTATIVE - Complete an SCS-1 form for all NCVS interviewed people ages 12-18. Do NOT complete an SCS-1 form for Type Z noninterview people or for people in Type A noninterview households. C. Type of SCS Interview 004 1  Personal - Self } 2  Telephone - Self } SKIP to INTRO 1 3  Personal - Proxy } 4  Telephone - Proxy } 5  Noninterview - FILL ITEM D		D. Reason for SCS noninterview 2  Refused 3  Not available
	INTRO 1 - Now I have some additional questions about your school. These answers will be kept confidential, by law.
	E. SCREEN QUESTIONS FOR SUPPLEMENT
	1a. Did you attend school at any time this school year? _________________________________________ 1b. During that time, were you ever home-schooled? That is, did you receive ANY of that schooling at home, rather than in a public or private school? _________________________________________ 1c. Was all of your schooling this school year home schooling?		1  Yes 2  No - END _____________________________________________ 1  Yes 2  No - SKIP to 2b ____________________________________________ 1  Yes - END 2  No
	2a. During the time you were home-schooled this school year, what grade would you have been in if you were in a public or private school?		0  Fifth or under - END 1  Sixth } 2  Seventh } 3  Eighth } 4  Ninth }SKIP to 5  Tenth }INTRO 2 6  Eleventh } 7  Twelfth } 8  Other - Specify ______________ } 9  College/GED/Post-graduate/ Other noneligible – END
	2b. What grade are you in?		0  Fifth or under - END 1  Sixth } 2  Seventh } 3  Eighth } 4  Ninth }SKIP 5  Tenth } to 3 6  Eleventh } 7  Twelfth } 8  Other - Specify ______________ } 9  College/GED/Post-graduate/ Other noneligible - END
	E. SCREEN QUESTIONS FOR SUPPLEMENT - Continued
	FIELD REPRESENTATIVE - Read introduction only if any of the boxes 1-8 are marked in item 2a. INTRO 2 - The following questions pertain only to your attendance at a public or private school and not to being home-schooled.
	3. In what month did your current school year begin?		1  August 2  September 3  Other - Specify ________________________
	F. ENVIRONMENTAL QUESTIONS
	6a. What is the complete name of your school? ________________________________________ 6b. In what city, county, and state is your school located?
	7a. Is your school public or private? ____________________________________________ 7b. Is this the regular school that most of the students in your neighborhood attend?		1  Public - ASK 7b 2  Private - SKIP to 7c ______________________________________________ 1  Yes } SKIP to 2  No } 8
	7c. Is your school affiliated with a religion?		1  Yes 2  No 3  Don’t know
	8. What grades are taught in your school? Pre-K or Kindergarten 00 01 02 03 04 05 06 07 08 09 10 11 12 H.S. Senior 13 Post-graduate 20 All ungraded 30 All Special Education		Grades:  (lowest) TO  (highest)
	9. How [do you/did you] get to school most of the time this school year? FIELD REPRESENTATIVE - If multiple modes are used, code the mode in which the student spends the most time.		1  Walk 2  School bus 3  Public bus, subway, train 4  Car 5  Bicycle, motorbike, or motorcycle 6  Some other way - Specify
	10. How long does it take you to get from your home to school most of the time?		1  Less than 15 minutes 2  15-29 minutes 3  30-44 minutes 4  45-59 minutes 5  60 minutes or longer
	11. How [do you/did you] get home from school most of the time this school year? FIELD REPRESENTATIVE - If multiple modes are used, code the mode in which the student spends the most time. If the student volunteers that he or she does not go directly home after school, record the mode that the student uses to get to his or her first destination after school.		1  Walk 2  School bus 3  Public bus, subway, train 4  Car 5  Bicycle, motorbike, or motorcycle 6  Some other way - Specify _____________________________
	12a. How often do you leave school grounds at lunch time? (READ CATEGORIES) ___________________________________________ 12b. Are students in your grade level allowed to leave school grounds to eat lunch?		1  Never 2  Once or twice a year 3  Once or twice a month 4  Once or twice a week 5  Almost every day ___________________________________________ 1  Yes 2  No 3  Don’t know
	13a. During this school year, have you participated in any of the following activities sponsored by your school: a. Athletic teams at school? b. Spirit groups, for example, Cheerleading, Dance Team, or Pep Club? c. Performing arts, for example, Band, Choir, Orchestra, or Drama? d. Academic clubs, for example, Debate Team, Honor Society, Spanish Club, or Math Club? e. Student government? f. [IF GRADES 6, 7, or 8] Community service or volunteer clubs sponsored by your school, for example, Peer Mediators, Ecology Club, or Recycling Club? [IF GRADES 9, 10, 11, or 12] Community service or volunteer clubs sponsored by your school, for example, Peer Mediators, Ecology Club, Key Club, or Interact? g. Other school clubs or school activities?			Yes No 1  2  1  2  1  2  1  2  1  2  1  2  1  2 
	13b. In a typical week, how much total time do you spend on all school-sponsored extra-curricular activities: (READ CATEGORIES)			1  None 2  Less than 1 hour per week 3  1-4 hours per week 4  5-9 hours per week 5  10-19 hours per week 6  20 or more hours per week
	14a. Does your school take any measures to make sure students are safe? For example, does the school have: a. Security guards or assigned police officers? b. Other school staff or other adults supervising the hallway? c. Metal detectors? d. Locked entrance or exit doors during the day? e. A requirement that visitors sign in? f. Locker checks? g. A requirement that students wear badges or picture identification? h. One or more security cameras to monitor the school? i. A code of student conduct, that is, a set of written rules or guidelines that the school provides you?			Yes No Don’t know Not Applicable 1  2  3  1  2  3  1  2  3  1  2  3  1  2  3  1  2  3  4  1  2  3  1  2  3  1  2  3 
	14b. If you hear about a threat to school or student safety, do you have a way to report it to someone in authority without giving your name? FIELD REPRESENTATIVE - The term ‘authority’ includes the police, teachers, principals, security guards, or other school staff. It does not include the student’s parents, guardians, or peers.			Yes No Don’t know 1  2  3 
	15a. In your classes, how often are you distracted from doing your schoolwork because other students are misbehaving, for example, talking or fighting? (READ CATEGORIES.) _____________ ______________________________ 15b. In general, how often do teachers punish students during your classes? (READ CATEGORIES.)			1  Never 2  Almost never 3  Sometimes 4  Most of the time __________________________ 1  Never 2  Almost never 3  Sometimes 4  Most of the time
	16a. I am going to read a list of statements that could describe a school. Thinking about your school, would you strongly agree, agree, disagree, or strongly disagree with the following... a. Everyone knows what the school rules are b. The school rules are fair. c. The punishment for breaking school rules is the same no matter who you are. d. The school rules are strictly enforced. e. If a school rule is broken, students know what kind of punishment will follow.			Strongly Strongly Agree Agree Disagree Disagree 1  2  3  4  1  2  3  4  1  2  3  4  1  2  3  4  1  2  3  4 
	16b. Thinking about the TEACHERS at your school, would you strongly agree, agree, disagree, or strongly disagree with the following… Teachers treat students with respect. b. Teachers care about students. c. Teachers do or say things that make students feel bad about themselves.			Strongly Strongly Agree Agree Disagree Disagree 1  2  3  4  1  2  3  4  1  2  3  4 
	16c. There is an ADULT at school who… Really cares about me Notices when I’m not there. Listens to me when I have something to say Tells me when I do a good job. Always wants me to do my best. Believes that I will be a success.			Strongly Strongly Agree Agree Disagree Disagree 1  2  3  4  1  2  3  4  1  2  3  4  1  2  3  4  1  2  3  4  1  2  3  4 
	16d. Thinking about FRIENDS at your school, would you strongly agree, agree, disagree, or strongly disagree with the following... a. At school, you have a FRIEND you can talk to, who cares about your feelings and what happens to you.			Strongly Strongly Agree Agree Disagree Disagree 1  2  3  4 
	16e. Thinking about the neighborhood where you live, would you strongly agree, agree, disagree, or strongly disagree with the following… a. There is a lot of crime in the neighborhood where I live. I feel safe in the neighborhood where I live.			Strongly Strongly Agree Agree Disagree Disagree 1  2  3  4  1  2  3  4 
	16f. Thinking about the neighborhood where your school is located, would you strongly agree, agree, disagree, or strongly disagree with the following... There is a lot of crime in the neighborhood where I go to school. I feel safe in the neighborhood where I go to school.			Strongly Strongly Agree Agree Disagree Disagree 1  2  3  4  1  2  3  4 
	INTRO 3 - Now I have some questions about things that happen at school. For this survey, “at school” includes the school building, on school property, on a school bus, or going to and from school. Your answers will not be given to anyone.
	17a. The following question refers to the availability of drugs and alcohol at your school. Tell me if you don’t know what any of these items are. FIELD REPRESENTATIVE - For “Don’t Know” responses, probe if necessary to determine if respondent means they do not know if the drug is available or if they do not know the drug. FIELD REPRESENTATIVE - For each item ask, Is it possible to get _______________ at your school? a. Alcoholic beverages b. Marijuana c. Crack d. Other forms of cocaine e. Uppers such as ecstasy, crystal meth or other illegal stimulants f. Downers such as GHB or sleeping pills g. LSD or acid h. PCP or angel dust i. Heroin or smack j. Prescription drugs illegally obtained without a prescription, such as Oxycontin, Vicodin, or Xannax k. Other illegal drugs If “Yes” is marked, ASK - What drugs? (Exclude tobacco products.) FIELD REPRESENTATIVE - Refer to Drug Slang Card (SCS-2). Reclassify the “other illegal drug(s)” to one of the categories a-I if possible. If able to reclassify the drug(s) mentioned, mark the “No” box in category j, otherwise, mark the “Yes” box in category j and enter the “other illegal drug(s)” mentioned in the Specify space.		Don’t Yes No Don’t know know drug 1  2  3  4  1  2  3  4  1  2  3  4  1  2  3  4  1  2  3  4  1  2  3  4  1  2  3  4  1  2  3  4  1  2  3  4  1  2  3  4  1  2  3  4   Specify _________________________________
	17b. During this school year, did you know for sure that any students were on drugs or alcohol while they were at school?		1  Yes 2  No
	17c. During this school year, did anyone offer, or try to sell or give you an illegal drug other than alcohol or tobacco at your school?		1  Yes 2  No
	G. FIGHTING, BULLYING AND HATE BEHAVIORS
	18a. During this school year, have you been in one or more physical fights at school?		1  Yes 2  No - SKIP to 19a
	18b. During this school year, how many times have you been in a physical fight at school?		 (Number of times)
	19a. Now I have some questions about what students do at school that make you feel bad or are hurtful to you. We often refer to this as being bullied. You may include events you told me about already. During this school year, has any student bullied you? That is, has another student... (Read each category a-g.) a. Made fun of you, called you names, or insulted you? b. Spread rumors about you or tried to make others dislike you? c. Threatened you with harm? d. Pushed you, shoved you, tripped you, or spit on you? e. Tried to make you do things you did not want to do, for example, give them money or other things? f. Excluded you from activities on purpose? g. Destroyed your property on purpose?		Yes No 1  2  1  2  1  2  1  2  1  2  1  2  1  2 
	Check Item 19a Are all categories a-g marked “No” in Q19a above?		1  Yes - SKIP to 20a 2  No - SKIP to 19b
	19b. You just indicated that someone had bullied you during this school year. Thinking about all of ways in which you were bullied, how often did all of those things happen? (READ CATEGORIES 1-4.)		1  Once or twice this school year 2  Once or twice a month 3  Once or twice a week, or 4  Almost every day 5  Don’t know
	19c. Still thinking about all of times you were bullied, where did the bullying occur? Did it occur … (READ CATEGORIES) Mark (X) all that apply		1  In a classroom at school? 2  In a hallway or stairwell at school? 3  In a bathroom or locker room at school? 3  Somewhere else inside the school building? - Specify _______________________ 4  Outside on school grounds? 145 5  On a school bus?
	19d. Was a teacher or some other adult at school notified about this bullying?		1  Yes 2  No
	CHECK Is Box 4 in Question 19a marked? Item B		1  Yes - Ask 19e 2  No - Skip to 20a
	19e. What were the injuries you suffered as a result of being pushed, shoved, tripped, or spit on? Mark (X) all that apply		1  None 2  Bruises or swelling 3  Cuts, scratches, or scrapes 4  Black eye/bloody nose 5  Teeth chipped or knocked out 6  Broken bones/internal injuries 7  Knocked unconscious 8  Other - Specify _______________________
	20a. Now I have some questions about what students do that could occur anywhere and that make you feel bad or are hurtful to you. You may include events you told me about already. During this school year, has another student.... (Read each category a-f.) a. Posted hurtful information about you on the Internet, for example, on a social networking site like MySpace, Facebook, Formspring or Twitter? b. Purposely shared your private information, photos or videos on the Internet or mobile phones in a hurtful way? c. Threatened or insulted you through email? d. Threatened or insulted you through instant messaging? e. Threatened or insulted you through text messaging? f. Threatened or insulted you through online gaming, for example, while playing XBOX or World of Warcraft; or similar activities such as Second Life? g. Purposefully excluded you from online communications?		Yes No 1  2  1  2  1  2  1  2  1  2  1  2  1  2 
	Check Item 20a Are all categories a-f marked “No” in Q20a above?		1  Yes - SKIP to 21a 2  No - SKIP to 20b
	20b. You just indicated that someone had bullied you during this school year. Thinking about all of ways in which you were bullied, how often did all of those things happen? (READ CATEGORIES 1-4)		1  Once or twice this school year 2  Once or twice a month 3  Once or twice a week, or 4  Almost every day 5  Don’t know
	20c. Was a teacher or some other adult at school notified about this bullying?		1  Yes 2  No
	21a. During this school year, has anyone called you an insulting or bad name at school having to do with your race, religion, ethnic background or national origin, disability, gender, or sexual orientation? We call these hate-related words.		1  Yes 2  No - SKIP to 22
	21b. Were any of the hate-related words related to ... a. Your race? b. Your religion? c. Your ethnic background or national origin (for example, people of Hispanic origin)? d. Any disability (by this I mean physical, mental, or developmental disabilities) you may have? e. Your gender? f. Your sexual orientation? If “Yes,” SAY - (by this we mean homosexual, bisexual, or heterosexual)		Yes No Don’t know 1  2  3  1  2  3  1  2  3  1  2  3  1  2  3  1  2  3 
	22. During this school year, have you seen any hate-related words or symbols written in school classrooms, school bathrooms, school hallways, or on the outside of your school building?		1  Yes 2  No
23a. During this school year, did you ever STAY AWAY from any of the following places because you thought someone might attack or harm you there? (READ CATEGORIES.) a. The shortest route to school? b. The entrance into the school? c. Any hallways or stairs in school? d. Parts of the school cafeteria? e. Any school restrooms? f. Other places inside the school building? g. School parking lot? h. Other places on school grounds?		Yes No 1  2  1  2  1  2  1  2  1  2  1  2  1  2  1  2 
23d. During this school year, did you STAY AWAY from any online activities because you thought someone might harm you there?”		Yes No 1  2 
	23b. Did you AVOID any activities at your school because you thought someone might attack or harm you?		1  Yes 2  No
	23c. Did you AVOID any classes because you thought someone might attack or harm you?		1  Yes 2  No
	23d. Did you stay home from school because you thought someone might attack or harm you in the school building, on school property, on a school bus, or going to or from school?		1  Yes 2  No
	I. FEAR
	24. How often are you afraid that someone will attack or harm you in the school building or on school property? (READ CATEGORIES.)		1  Never 2  Almost never 3  Sometimes 4  Most of the time
	25. How often are you afraid that someone will attack or harm you on a school bus or on the way to and from school? (READ CATEGORIES)		1  Never 2  Almost never 3  Sometimes 4  Most of the time
	26. Besides the times you are in the school building, on school property, on a school bus, or going to or from school, how often are you afraid that someone will attack or harm you? (READ CATEGORIES)		1  Never 2  Almost never 3  Sometimes 4  Most of the time
	J. WEAPONS
	27. Some people bring guns, knives, or objects that can be used as weapons to school for protection. During this school year, did YOU ever bring the following to school or onto school grounds? (READ CATEGORIES.) a. A gun? b. A knife brought as a weapon? c. Some other weapon?		Yes No 1  2  1  2  1  2 
	28a. Do you know of any other students who have brought a gun to your school during this school year?		1  Yes 2  No - Skip to 29
	28b. Have you actually seen another student with a gun at school during this school year?		1  Yes 2  No 3  Don’t know
	29. During this school year, could you have gotten a loaded gun without adult permission, either at school or away from school?		1  Yes 2  No
	K. GANGS
	INTRO 4 - Now, we'd like to know about gangs at your school. You may know these as street gangs, fighting gangs, crews, or something else. Gangs may use common names, signs, symbols, or colors. For this survey, we are interested in all gangs, whether or not they are involved in violent or illegal activity. Your responses are confidential.
	30. Are there any gangs at your school?		1  Yes 2  No - SKIP to 33a 3  Don't know
	31. During this school year, how often have gangs been involved in fights, attacks, or other violence at your school? (READ CATEGORIES 1-5)		1  Never 2  Once or twice this school year 3  Once or twice a month 4  Once or twice a week, or 5  Almost every day 6  Don't know
	32. Have gangs been involved in the sale of drugs at your school during this school year?		1  Yes 2  No 3  Don't know
	L. STUDENT CHARACTERISTICS
	33. During this school year, across all subjects have you gotten mostly - (READ CATEGORIES 1-5)		1  A's 2  B's 3  C's 4  D's 5  F's 6  School does not give grades/no alphabetic grade equivalent
	34a. During the last 4 weeks of school, did you skip any classes?		1  Yes 2  No - SKIP to 35 3  Don't know - SKIP to 35
	34b. During the last 4 weeks of school, on how many days did you skip at least one class?		 (Number of days)
	35. Thinking about the future, do you think you will ... a. Attend school after high school, such as a technical school or college? . . . . . . . . . . b. Graduate from a 4-year college? . . . . . . . . . . .		Yes No Don't know 1  2  -- END 3   2  3 

Version B
ASK OF ALL PEOPLE AGES 12-18	FORM SCS-1 U.S. DEPARTMENT OF COMMERCE Economics and Statistics Administration U.S. Census Bureau ACTING AS COLLECTING AGENCY FOR THE BUREAU OF JUSTICE STATISTICS U.S. DEPARTMENT OF JUSTICE SCHOOL CRIME SUPPLEMENT TO THE NATIONAL CRIME VICTIMIZATION SURVEY 2011 QUESTIONNAIRE
We estimate that it will take from 5 to 15 minutes to complete this interview with 10 minutes being the average time. If you have any comments regarding these estimates or any other aspect of this survey, send them to the Associate Director for Finance and Administration, Room 2027, U.S. Census Bureau, Washington DC 20233, or to the Office of Information and Regulatory Affairs, Office of Management and Budget, Washington, DC 20503. According to the Paperwork Reduction Act of 1995, no such persons are required to respond to a collection of information unless such collection displays a valid OMB control number.
Control number PSU Segment/Suffix Sample Designation/Suffix Serial/Suffx HH No. Spinoff Indicator

A. FR Code 001 

B. Respondent Line No. Age Name 002  003 

FIELD REPRESENTATIVE - Complete an SCS-1 form for all NCVS interviewed people ages 12-18. Do NOT complete an SCS-1 form for Type Z noninterview people or for people in Type A noninterview households. C. Type of SCS Interview 004 1  Personal - Self } 2  Telephone - Self } SKIP to INTRO 1 3  Personal - Proxy } 4  Telephone - Proxy } 5  Noninterview - FILL ITEM D		D. Reason for SCS noninterview 2  Refused 3  Not available
INTRO 1 - Now I have some additional questions about your school. These answers will be kept confidential, by law.
E. SCREEN QUESTIONS FOR SUPPLEMENT
1a. Did you attend school at any time this school year? _________________________________________ 1b. During that time, were you ever home-schooled? That is, did you receive ANY of that schooling at home, rather than in a public or private school? _________________________________________ 1c. Was all of your schooling this school year home schooling?		1  Yes 2  No - END _____________________________________________ 1  Yes 2  No - SKIP to 2b ____________________________________________ 1  Yes - END 2  No
2a. During the time you were home-schooled this school year, what grade would you have been in if you were in a public or private school?		0  Fifth or under - END 1  Sixth } 2  Seventh } 3  Eighth } 4  Ninth }SKIP to 5  Tenth }INTRO 2 6  Eleventh } 7  Twelfth } 8  Other - Specify ______________ } 9  College/GED/Post-graduate/ Other noneligible – END
2b. What grade are you in?		0  Fifth or under - END 1  Sixth } 2  Seventh } 3  Eighth } 4  Ninth }SKIP 5  Tenth } to 3 6  Eleventh } 7  Twelfth } 8  Other - Specify ______________ } 9  College/GED/Post-graduate/ Other noneligible - END
E. SCREEN QUESTIONS FOR SUPPLEMENT - Continued
FIELD REPRESENTATIVE - Read introduction only if any of the boxes 1-8 are marked in item 2a. INTRO 2 - The following questions pertain only to your attendance at a public or private school and not to being home-schooled.
3. In what month did your current school year begin?		1  August 2  September 3  Other - Specify ________________________
F. ENVIRONMENTAL QUESTIONS
6a. What is the complete name of your school? ________________________________________ 6b. In what city, county, and state is your school located?
7a. Is your school public or private? ____________________________________________ 7b. Is this the regular school that most of the students in your neighborhood attend?		1  Public - ASK 7b 2  Private - SKIP to 7c ______________________________________________ 1  Yes } SKIP to 2  No } 8
7c. Is your school affiliated with a religion?		1  Yes 2  No 3  Don’t know
8. What grades are taught in your school? Pre-K or Kindergarten 00 01 02 03 04 05 06 07 08 09 10 11 12 H.S. Senior 13 Post-graduate 20 All ungraded 30 All Special Education		Grades:  (lowest) TO  (highest)
9. How [do you/did you] get to school most of the time this school year? FIELD REPRESENTATIVE - If multiple modes are used, code the mode in which the student spends the most time.		1  Walk 2  School bus 3  Public bus, subway, train 4  Car 5  Bicycle, motorbike, or motorcycle 6  Some other way - Specify
10. How long does it take you to get from your home to school most of the time?		1  Less than 15 minutes 2  15-29 minutes 3  30-44 minutes 4  45-59 minutes 5  60 minutes or longer
11. How [do you/did you] get home from school most of the time this school year? FIELD REPRESENTATIVE - If multiple modes are used, code the mode in which the student spends the most time. If the student volunteers that he or she does not go directly home after school, record the mode that the student uses to get to his or her first destination after school.		1  Walk 2  School bus 3  Public bus, subway, train 4  Car 5  Bicycle, motorbike, or motorcycle 6  Some other way - Specify _____________________________
12a. How often do you leave school grounds at lunch time? (READ CATEGORIES) ___________________________________________ 12b. Are students in your grade level allowed to leave school grounds to eat lunch?		1  Never 2  Once or twice a year 3  Once or twice a month 4  Once or twice a week 5  Almost every day ___________________________________________ 1  Yes 2  No  Don’t know
	13a. During this school year, have you participated in any of the following activities sponsored by your school: a. Athletic teams at school? b. Spirit groups, for example, Cheerleading, Dance Team, or Pep Club? c. Performing arts, for example, Band, Choir, Orchestra, or Drama? d. Academic clubs, for example, Debate Team, Honor Society, Spanish Club, or Math Club? e. Student government? f. [IF GRADES 6, 7, or 8] Community service or volunteer clubs sponsored by your school, for example, Peer Mediators, Ecology Club, or Recycling Club? [IF GRADES 9, 10, 11, or 12] Community service or volunteer clubs sponsored by your school, for example, Peer Mediators, Ecology Club, Key Club, or Interact? g. Other school clubs or school activities?		Yes No 1  2  1  2  1  2  1  2  1  2  1  2  1  2 
	13b. In a typical week, how much total time do you spend on all school-sponsored extra-curricular activities: (READ CATEGORIES)		1  None 2  Less than 1 hour per week 3  1-4 hours per week 4  5-9 hours per week 5  10-19 hours per week 6  20 or more hours per week
	14a. Does your school take any measures to make sure students are safe? For example, does the school have: a. Security guards or assigned police officers? b. Other school staff or other adults supervising the hallway? c. Metal detectors? d. Locked entrance or exit doors during the day? e. A requirement that visitors sign in? f. Locker checks? g. A requirement that students wear badges or picture identification? h. One or more security cameras to monitor the school? i. A code of student conduct, that is, a set of written rules or guidelines that the school provides you?		Yes No Don’t know Not Applicable 1  2  3  1  2  3  1  2  3  1  2  3  1  2  3  1  2  3  4  1  2  3  1  2  3  1  2  3 
	14b. If you hear about a threat to school or student safety, do you have a way to report it to someone in authority without giving your name? FIELD REPRESENTATIVE - The term ‘authority’ includes the police, teachers, principals, security guards, or other school staff. It does not include the student’s parents, guardians, or peers.		Yes No Don’t know 1  2  3 
	15a. In your classes, how often are you distracted from doing your schoolwork because other students are misbehaving, for example, talking or fighting? (READ CATEGORIES.) _____________ ______________________________ 15b. In general, how often do teachers punish students during your classes? (READ CATEGORIES.)		1  Never 2  Almost never 3  Sometimes 4  Most of the time __________________________ 1  Never 2  Almost never 3  Sometimes  Most of the time
	16a. I am going to read a list of statements that could describe a school. Thinking about your school, would you strongly agree, agree, disagree, or strongly disagree with the following... a. Everyone knows what the school rules are b. The school rules are fair. c. The punishment for breaking school rules is the same no matter who you are. d. The school rules are strictly enforced. If a school rule is broken, students know what kind of punishment will follow.		Strongly Strongly Agree Agree Disagree Disagree 1  2  3  4  1  2  3  4  1  2  3  4  1  2  3  4  1  2  3  4 
	16b. Thinking about the TEACHERS at your school, would you strongly agree, agree, disagree, or strongly disagree with the following… Teachers treat students with respect. b. Teachers care about students. c. Teachers do or say things that make students feel bad about themselves.		Strongly Strongly Agree Agree Disagree Disagree 1  2  3  4  1  2  3  4  1  2  3  4 
	16c. There is an ADULT at school who… Really cares about me Notices when I’m not there. Listens to me when I have something to say Tells me when I do a good job. Always wants me to do my best. Believes that I will be a success.		Strongly Strongly Agree Agree Disagree Disagree 1  2  3  4  1  2  3  4  1  2  3  4  1  2  3  4  1  2  3  4  1  2  3  4 
	16d. Thinking about FRIENDS at your school, would you strongly agree, agree, disagree, or strongly disagree with the following... a. At school, you have a FRIEND you can talk to, who cares about your feelings and what happens to you.		Strongly Strongly Agree Agree Disagree Disagree 1  2  3  4 
	16e. Thinking about the neighborhood where you live, would you strongly agree, agree, disagree, or strongly disagree with the following… a. There is a lot of crime in the neighborhood where I live. I feel safe in the neighborhood where I live.		Strongly Strongly Agree Agree Disagree Disagree 1  2  3  4  1  2  3  4 
	16f. Thinking about the neighborhood where your school is located, would you strongly agree, agree, disagree, or strongly disagree with the following... There is a lot of crime in the neighborhood where I go to school. I feel safe in the neighborhood where I go to school.		Strongly Strongly Agree Agree Disagree Disagree 1  2  3  4  1  2  3  4 
INTRO 3 - Now I have some questions about things that happen at school. For this survey, “at school” includes the school building, on school property, on a school bus, or going to and from school. Your answers will not be given to anyone.
17a. The following question refers to the availability of drugs and alcohol at your school. Tell me if you don’t know what any of these items are. FIELD REPRESENTATIVE - For “Don’t Know” responses, probe if necessary to determine if respondent means they do not know if the drug is available or if they do not know the drug. FIELD REPRESENTATIVE - For each item ask, Is it possible to get _______________ at your school? a. Alcoholic beverages b. Marijuana c. Crack d. Other forms of cocaine e. Uppers such as ecstasy, crystal meth or other illegal stimulants f. Downers such as GHB or sleeping pills g. LSD or acid h. PCP or angel dust i. Heroin or smack j. Prescription drugs illegally obtained without a prescription, such as Oxycontin, Vicodin, or Xannax k. Other illegal drugs If “Yes” is marked, ASK - What drugs? (Exclude tobacco products.) FIELD REPRESENTATIVE - Refer to Drug Slang Card (SCS-2). Reclassify the “other illegal drug(s)” to one of the categories a-I if possible. If able to reclassify the drug(s) mentioned, mark the “No” box in category j, otherwise, mark the “Yes” box in category j and enter the “other illegal drug(s)” mentioned in the Specify space.		Don’t Yes No Don’t know know drug 1  2  3  4  1  2  3  4  1  2  3  4  1  2  3  4  1  2  3  4  1  2  3  4  1  2  3  4  1  2  3  4  1  2  3  4  1  2  3  4  1  2  3  4   Specify _________________________________
17b. During this school year, did you know for sure that any students were on drugs or alcohol while they were at school?		1  Yes 2  No
17c. During this school year, did anyone offer, or try to sell or give you an illegal drug other than alcohol or tobacco at your school?		1  Yes 2  No
G. FIGHTING, BULLYING AND HATE BEHAVIORS
18a. During this school year, have you been in one or more physical fights at school?		1  Yes 2  No - SKIP to 19a
18b. During this school year, how many times have you been in a physical fight at school?		 (Number of times)
19a. Now I have some questions about what students do at school that make you feel bad or are hurtful to you. We often refer to this as being bullied. You may include events you told me about already. During this school year, has any student bullied you? That is, has another student... (Read each category a-g.) a. Made fun of you, called you names, or insulted you? b. Spread rumors about you or tried to make others dislike you? c. Threatened you with harm? d. Pushed you, shoved you, tripped you, or spit on you? e. Tried to make you do things you did not want to do, for example, give them money or other things? f. Excluded you from activities on purpose? g. Destroyed your property on purpose?		Yes No 1  2  1  2  1  2  1  2  1  2  1  2  1  2 
Check Item 19a Are all categories a-g marked “No” in Q19a above?		1  Yes - SKIP to 20a 2  No - SKIP to 19b
19b. You just indicated that someone had bullied you during this school year. Thinking about all of ways in which you were bullied, how often did all of those things happen? (READ CATEGORIES 1-4.)		1  Once or twice this school year 2  Once or twice a month 3  Once or twice a week, or 4  Almost every day 5  Don’t know
19c. Still thinking about all of times you were bullied, where did the bullying occur? Did it occur … (READ CATEGORIES) Mark (X) all that apply		1  In a classroom at school? 2  In a hallway or stairwell at school? 3  In a bathroom or locker room at school? 3  Somewhere else inside the school building? - Specify _______________________ 4  Outside on school grounds? 145 5  On a school bus?
19d. Was a teacher or some other adult at school notified about this bullying?		1  Yes 2  No
CHECK Is Box 4 in Question 19a marked? Item B		1  Yes - Ask 19e 2  No - Skip to 20a
19e. What were the injuries you suffered as a result of being pushed, shoved, tripped, or spit on? Mark (X) all that apply		1  None 2  Bruises or swelling 3  Cuts, scratches, or scrapes 4  Black eye/bloody nose 5  Teeth chipped or knocked out 6  Broken bones/internal injuries 7  Knocked unconscious 8  Other - Specify _______________________
20a. Now I have some questions about what students do that could occur anywhere and that make you feel bad or are hurtful to you. You may include events you told me about already. During this school year, has another student.... (Read each category a-f.) a. Posted hurtful information about you on the Internet, for example, on a social networking site like MySpace, Facebook, Formspring or Twitter? b. Purposely shared your private information, photos or videos on the Internet or mobile phones in a hurtful way? c. Threatened or insulted you through email? d. Threatened or insulted you through instant messaging? e. Threatened or insulted you through text messaging? f. Threatened or insulted you through online gaming, for example, while playing XBOX or World of Warcraft; or similar activities such as Second Life? g. Purposefully excluded you from online activities?		Yes No 1  2  1  2  1  2  1  2  1  2  1  2  1  2 
Check Item 20a Are all categories a-f marked “No” in Q20a above?		1  Yes - SKIP to 21a 2  No - SKIP to 20b
20b. You just indicated that someone had bullied you during this school year. Thinking about all of ways in which you were bullied, how often did all of those things happen? (READ CATEGORIES 1-4)		1  Once or twice this school year 2  Once or twice a month 3  Once or twice a week, or 4  Almost every day 5  Don’t know
20c. Was a teacher or some other adult at school notified about this bullying?		1  Yes 2  No
21a. During this school year, has anyone called you an insulting or bad name at school having to do with your race, religion, ethnic background or national origin, disability, gender, or sexual orientation? We call these hate-related words.		1  Yes 2  No - SKIP to 22
21b. Were any of the hate-related words related to ... a. Your race? b. Your religion? c. Your ethnic background or national origin (for example, people of Hispanic origin)? d. Any disability (by this I mean physical, mental, or developmental disabilities) you may have? e. Your gender? f. Your sexual orientation? If “Yes,” SAY - (by this we mean homosexual, bisexual, or heterosexual)		Yes No Don’t know 1  2  3  1  2  3  1  2  3  1  2  3  1  2  3  1  2  3 
22. During this school year, have you seen any hate-related words or symbols written in school classrooms, school bathrooms, school hallways, or on the outside of your school building?		1  Yes 2  No
23a. During this school year, did you ever STAY AWAY from any of the following places because you thought someone might attack or harm you there? (READ CATEGORIES.) a. The shortest route to school? b. The entrance into the school? c. Any hallways or stairs in school? d. Parts of the school cafeteria? e. Any school restrooms? f. Other places inside the school building? g. School parking lot? h. Other places on school grounds? i. Certain online activities?		Yes No 1  2  1  2  1  2  1  2  1  2  1  2  1  2  1  2  1  2 
23b. Did you AVOID any activities at your school because you thought someone might attack or harm you?		1  Yes 2  No
23c. Did you AVOID any classes because you thought someone might attack or harm you?		1  Yes 2  No
23d. Did you stay home from school because you thought someone might attack or harm you in the school building, on school property, on a school bus, or going to or from school?		1  Yes 2  No
I. FEAR
24. How often are you afraid that someone will attack or harm you in the school building or on school property? (READ CATEGORIES.)		1  Never 2  Almost never 3  Sometimes 4  Most of the time
25. How often are you afraid that someone will attack or harm you on a school bus or on the way to and from school? (READ CATEGORIES)		1  Never 2  Almost never 3  Sometimes 4  Most of the time
26. Besides the times you are in the school building, on school property, on a school bus, or going to or from school, how often are you afraid that someone will attack or harm you? (READ CATEGORIES)		1  Never 2  Almost never 3  Sometimes 4  Most of the time
J. WEAPONS
27. Some people bring guns, knives, or objects that can be used as weapons to school for protection. During this school year, did YOU ever bring the following to school or onto school grounds? (READ CATEGORIES.) a. A gun? b. A knife brought as a weapon? c. Some other weapon?		Yes No 1  2  1  2  1  2 
28a. Do you know of any other students who have brought a gun to your school during this school year?		1  Yes 2  No - Skip to 29
28b. Have you actually seen another student with a gun at school during this school year?		1  Yes 2  No 3  Don’t know
29. During this school year, could you have gotten a loaded gun without adult permission, either at school or away from school?		1  Yes 2  No
K. GANGS
INTRO 4 - Now, we'd like to know about gangs at your school. You may know these as street gangs, fighting gangs, crews, or something else. Gangs may use common names, signs, symbols, or colors. For this survey, we are interested in all gangs, whether or not they are involved in violent or illegal activity. Your responses are confidential.
30. Are there any gangs at your school?		1  Yes 2  No - SKIP to 33a 3  Don't know
31. During this school year, how often have gangs been involved in fights, attacks, or other violence at your school? (READ CATEGORIES 1-5)		1  Never 2  Once or twice this school year 3  Once or twice a month 4  Once or twice a week, or 5  Almost every day 6  Don't know
32. Have gangs been involved in the sale of drugs at your school during this school year?		1  Yes 2  No 3  Don't know
L. STUDENT CHARACTERISTICS
33. During this school year, across all subjects have you gotten mostly - (READ CATEGORIES 1-5)		1  A's 2  B's 3  C's 4  D's 5  F's 6  School does not give grades/no alphabetic grade equivalent
34a. During the last 4 weeks of school, did you skip any classes?		1  Yes 2  No - SKIP to 35 3  Don't know - SKIP to 35
34b. During the last 4 weeks of school, on how many days did you skip at least one class?		 (Number of days)

35. Thinking about the future, do you think you will ... a. Attend school after high school, such as a technical school or college? . . . . . . . . . . b. Graduate from a 4-year college? . . . . . . . . . . .

Yes No Don't know 1  2  -- END 3   2  3 