19,228 notes
8 months ago

Have to do an anonymous survey for school, so put a | next to everything you've been called/ applies to you. Put a [space] between all tally marks. Do not change this title, and do not add anything to the list or tamper with the tally marks, please.

  • Fat: | | | | | | | | | | | | | | | | | | | | | | | | | | |
  • Ugly: | | | | | | | | | | l | | | | | | | | | | | | | | | | | | | | |
  • Worthless: | | | | | | | | | | | | | | | | | | | | | | | | | | | |
  • Emo: | | | | | | | | | | | | | | | | | | | |
  • Antisocial: | | | | | | | | | | | | | | | | | | | | | | | | | | |
  • Weird: | | | | | | | | | l I | | | | | | | | | | | | | | | | | | | |
  • Freak: | | | | | | | | | | | | | | | | | | | | | | | | | |
  • Bully: | | | | | | |
  • Stupid: | | | | | | | | | | | | l I | | | | | | | | | | | | | |
  • Snob: | | | | | | | | | | |
  • Dirty: | | | | | | | | | | | | | | |
  • Trash: | | | | | | | | | | | |
  • Bitch: | | | | | | | | | l I | | | | | | | | | | | | | |
  • Whore: | | | | | | | | | | | | | | |
  • Slut: | | | | | | | | | | | | |
  • Skank: | | | | | | | | |
  • Homewrecker: | |
  • _____________________________________
  • Have been bullied by a teacher: | | | l | | | | | | | | | |
  • Have been bullied by a student: | | | | | | | | | | | l | | | | | | | | | | | | | | | | | | |
  • Have been bullied by family: | | | | | | | | | l | | | | | | | | | | | | | |
  • Have been bullied at work: | | |
  • Have been raped: | | | | |
  • Have been beaten: | | | | | | | | | |
  • Have been cyberbullied: | | | | | | | | l | | | | | | | | | |
  • __________________________________________
  • Suicidal: | | | | | | | | | l | | | | | | | | | | | | | |
  • Depressed: | | | | | | | | | | | | | | | | | | | | | | | | | |
  • Self-harm: | | | | | | | | | | | | | | | | | | | | | | |
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