Have to do an anonymous survey for school, so put a | next to everything you've been called/ applies to you. Put a [space] between all tally marks. Do not change this title, and do not add anything to the list or tamper with the tally marks, please.

• Fat:

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• Ugly:

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• Worthless:

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• Emo:

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• Antisocial:

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• Weird:

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• Freak:

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• Bully:

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• Stupid:

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• Snob:

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• Dirty:

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• Trash:

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• Bitch:

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• Whore:

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• Slut:

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• Skank:

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• Homewrecker:

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• _____________________________________

• Have been bullied by a teacher:

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• Have been bullied by a student:

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• Have been bullied by family:

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• Have been bullied at work:

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• Have been raped:

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• Have been beaten:

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• Have been cyberbullied:

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• __________________________________________

• Suicidal:

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• Depressed:

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• Self-harm:

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• From: Talk Disney To Me
• undertheseaatdisney
• Origin: Ew, it's you