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| Please indicate your gender. |
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| Please indicate your age. |
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| How many years have you been in the Teton School District? |
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| How would you classify yourself? |
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| How would you classify yourself? |
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| During the last week, how many times, if any, has someone pushed you, shoved you, tripped you or spit on you? |
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| During the last week, how many times, if any, has someone threatened you with harm? |
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| During the last week, how many times, if any, has someone tried to make you do something you did not want to do; for example, give them money or other things? |
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