Carolyn N. Kinder
Name____________Grade_______ Age_______ Location of school_________
Use the following scale for the following questions:
1: None, 2: Low, 3: Average, 4: High, 5: Very high
1.
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_______ How do you rate the overall violence in your middle school?
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2.
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_______ How do you rate the overall violence in your community?
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3.
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_______ How do you rate the overall violence in your home?
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4.
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Rate the following concerning how you feel these subjects lead to school violence.
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______ Parental negligence (abuse, neglect, divorce, conflicting relationships, etc.)
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______ Peer pressure (treatment, fashion, reputations, etc.)
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______Entertainment (TV, Movies and Newsletters, etc.)
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______Treatment of students to each other
5.
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How do teachers tend to treat violence in your school?
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A.______Don’t need to worry about it because it rarely happens
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B.______Feels as though students have everything under control
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C. _____Often ignore or cover it up
6.
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Have you committed any acts of violence, small or serious____Yes____No
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7.
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Have any of your friends or relatives been victims of school violence? ___Yes___No
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8.
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________To what extend do you solve your problems using violence?
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9.
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________To what extend are you exposed to violence on a daily basis?
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10. ________To what extend do you practice being non-violent?