Respondent Impact Survey

Your Name

Type of Incident

Where did this happen?

If you were in class, which subject?

If you were in class, which teacher?

If you were off-campus, where were you?

How many people saw the incident?

Were the police called?

Which teachers or adult staff support you in a positive way?

Teacher relationship? How is your relationship with this teacher and others? Do you often have problems in this class? Other classes?

Have you been arrested in the last year? For what type of incident?

Have you been suspended already this year for other incidents? If so, how many times, and for what types of incidents?