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!
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

Do you have a smartphone (circle one)?

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

1. I would be comfortable letting my parents see my Twitter, Facebook, Instagram, etc.

1

2. My parents monitor my social media accounts regularly.

1

3. I use social media to promote positive messages.

1

4. My idea of what is right and wrong is influenced by social media.

1

5. I use social media to connect with a world outside my own.

1

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

8. I act differently on social media than I do in real life.

1

9. I see social media as a safe place to share.

1

10. I have made negative comments about someone on social media

1

11. The bullying I see on social media is directed at GLBTQ youth.

1

12. The bullying I see on social media is based on race.

1

13. The bullying I see on social media is based on what a person looks like (hair, clothes, weight).
1

14. I have been bullied by way of social media.

1

For the final question, please

please write in the space provided below:
What are the main things you use social media for?

_____________________________________________________________________________________

THANK YOU!