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This survey is
ANONYMOUS, meaning that I wont be able to know who answered each survey. The results of this
survey will be used to develop classroom guidance or other group activities. Thank you for your time!
Grade level______
Gender: ______________
Race (circle one): A. American Indian
B. Asian
C. Black/African-American
D. Multi-Racial
E. Pacific Islander
F. White
D. Latino/Hispanic
I use the following forms of social media (check all that apply)
___Facebook
___Reddit
___Twitter
___Vine
___Instagram
___YouTube
___Snapchat
___Tumblr
___Pinterest
___Kik
___Ask.fm
Other________________
*Note: Netflix, Hulu, Pandora, Spotify, or news sites (nytimes.com, etc.) are not being included as social media.
Message boards or online communities where you actively participate can be noted.
Approximate time spent using social media on a daily basis (circle one):
A. 0-60 minutes
B. 1-2 hours
C. 2-3 hours
YES
D. 3-4 hours
E. 4+ hours
NO
Using the following scale, please answer questions 1-14 (circle your answer):
answer):
1- Strongly Disagree
2- Disagree
3- Undecided
4- Agree
5- Strongly Agree
6. I would report any negative posts or threats that I saw on social media.
1
Please respond to the following questions in an honest and thoughtful manner. This survey is
ANONYMOUS, meaning that I wont be able to know who answered each survey. The results of this
survey will be used to develop classroom guidance or other group activities. Thank you for your time!
1- Strongly Disagree
2- Disagree
3- Undecided
4- Agree
5- Strongly Agree
7. I feel pressured by social media to look a certain way (i.e. wear the right clothes or hairstyle).
1
13. The bullying I see on social media is based on what a person looks like (hair, clothes, weight).
1
_____________________________________________________________________________________
THANK YOU!