Parents

Georgia Student Health Survey

Georgia Student Health Survey

Elementary Survey (Grades 3-5)

Demographic Information

Gender?

- Female

- Male

Ethnicity?

- Black or African American

- Hispanic or Latino

- White or Caucasian

- Asian or Pacific Islander

- Native American

- Mixed Race

- I prefer not to answer

Grade?

- 3rd

- 4th

- 5th

Survey Questions

For each of the statements below students have the following response options: always, often sometimes, or never.

1. I like school.

2. I feel like I do well in school.

3. My school wants me to do well.

4. My school has clear rules for behavior.

5. I feel safe at school.

6. Teachers treat me with respect.

7. Good behavior is noticed at my school.

8. Students in my class behave so teachers can teach.

9. I get along well with other students.

10. Students treat each other well.

11. There is an adult at my school who will help me if I need it.

For each of the questions below students have the following response options: never, once or twice, a few times, many times, every day.

How often in the past couple of months have older, bigger, more popular, or more powerful kids picked on you at school by…

12. hitting or kicking you.

13. spreading rumors about you.

14. threatening you.

15. leaving you out.