Aloha Potter
Student Survey
Name
Date
Instructions: For each sentence, fill in the circle next to the word “True” if you think the
statement is true, and fill in the circle next to the word “False” if you think the statement is
false. If you’re not sure of your answer, fill in the circle next to the words “I’m not sure.”
1. Things people say can hurt the feelings of other people a lot.
O True O False O I’m not sure
2. When someone is making fun of you, it usually does not do much good for you to show
the person how angry you are.
O True O False O I’m not sure
3. When people tease you and you don’t get angry, they will just want to tease you even
more.
O True O False O I’m not sure
4. You should keep on saying nice things to people even when you’ve been teased, because
it is the right thing to do.
O True O False O I’m not sure
5. People who say mean things about others should never stop, because it shows how brave
they are.
O True O False O I’m not sure
6. When someone is doing something wrong, it is always a good idea for you to tell your
friends about it, because that is a kind thing to do.
O True O False O I’m not sure
7. You don’t have to pay much attention to what you say, because words can’t really hurt
someone.
O True O False O I’m not sure
(This page may be duplicated.)
6
Aloha Potter
Student Survey
Name
Date
Instructions: For each sentence, fill in the circle next to the word “True” if you think the
statement is true, and fill in the circle next to the word “False” if you think the statement is
false. If you’re not sure of your answer, fill in the circle next to the words “I’m not sure.”
8. Even if it is mostly true, people who say things that hurt another person are doing
something very wrong.
O True O False O I’m not sure
9. A good way to get people to stop saying unkind things about you is to pay no attention
to them.
O True O False O I’m not sure
10. If people are teasing or are mean to others, usually ignoring them just one time will
make them quit.
O True O False O I’m not sure
11. It might take a while, but when people who are being mean see that they can’t make
you angry or sad, they’ll probably stop trying.
O True O False O I’m not sure
12. No one hurts people on purpose, so when people are hurting others, telling them to stop
will almost always work.
O True O False O I’m not sure
13. People who make fun of others or say mean things are really showing everyone
how tough they are.
O True O False O I’m not sure
14. If people are hurting your feelings by saying unkind things, they will almost always
stop if they just see how unhappy you are.
O True O False O I’m not sure
(This page may be duplicated.)
7
Aloha Potter
Student Survey
Name
Date
Instructions: For each sentence, fill in the circle next to the word “True” if you think the
statement is true, and fill in the circle next to the word “False” if you think the statement is
false. If you’re not sure of your answer, fill in the circle next to the words “I’m not sure.”
15. If you laugh at someone you could hurt that person’s feelings a lot.
O True O False O I’m not sure
16. If someone makes fun of you, it can be a good idea if you make the same joke about
yourself.
O True O False O I’m not sure
17. Being unkind to people who speak unkindly to you will help get them to stop, especially
if you get some others to be on your side.
O True O False O I’m not sure
18. Saying something nice to someone who is saying something mean to you is often the
best thing you can do.
O True O False O I’m not sure
19. Laughing at someone, especially if you really think it’s funny, usually shows that you
care a lot about that person.
O True O False O I’m not sure
20. It is never a good idea to ignore a person who says something unkind to you.
O True O False O I’m not sure
21. If someone is making fun of you, making fun back is probably going to help things
a lot.
O True O False O I’m not sure
(This page may be duplicated.)
8