Appendix A

Charlie Canning

University of Adelaide

QUESTIONNAIRE

TODAY’S DATE__________________
NAME* (optional)__________________________________________
PSEUDONYM (optional)____________________________________
CITY and PREFECTURE (optional)____________________________
AGE_________ MALE / FEMALE (please circle)

1) Who experienced the bullying? ME, SON, DAUGHTER, WIFE, HUSBAND, STUDENT, OTHER ____________ (Please circle one. If the bullying occurred to more than one person, please fill out a separate questionnaire for each person.)

2) When did the bullying occur? (Example: From April 2006-March 2007)

3) Where did the bullying occur?

4) Was it limited to the school or did you or your family member also experience bullying outside of school?

5) Please describe in as much detail as possible the nature of the bullying.

6) How many people were involved in the bullying?

7) How many people were aware that the bullying was going on?

8) How did it make you or your family member feel?

9) Where there any physical or psychological reactions to the bullying? What were they? (Sleeplessness, vomiting, diarrhea, muscle spasms, decreased mobility, etc.) How did you attempt to deal with these symptoms?

10) Did you or your family member stop going to school or stop leaving the house as a result of the bullying?

11) Did anyone come forward to help you or your family member while the bullying was going on?

12) Did you or your family member ever attempt to confront the people doing the bullying directly? Why or why not?

13) Did you or your family member report the bullying to someone in authority? (Example: Parent, teacher, principal, school board member, PTA representative, policeman, etc.) What action did they take to deal with the problem?

14) Did the bullying continue after you or your family member had contacted someone in authority?

15) Did a person in authority ever attempt to downplay the bullying or categorize it as “human relations” or “not getting along?”

16) Did a person in authority ever suggest that you or your relative was responsible for bringing the bullying on yourselves?

17) Did a person in authority ever criticize you or your family member for raising the issue of bullying? Did a person in authority ever criticize you for making a claim that you or your family member was being bullied?

18) What part did technology - if any - have in the bullying? Were cellular phones and Internet sites used to bully you or your relative?

19) Use the space below to continue your responses to any of the questions above by noting the question number. You are also free to write whatever you please (free space) about the subject of bullying in the schools or in society at large.

Thank you for taking part in this survey. Your responses will be used to provide depth to my research on the subject of bullying.

*Please note that I will not use a person’s real name in any publication without his or her consent. If you wish to remain completely anonymous, please give a pseudonym.

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