Gay‚ Lesbian‚ Straight‚ Education Network (GLSEN)

SECTION A
This first set of questions is about homophobic remarks you may have heard at your school. Please circle the answer that best describes your experience at your school.
1. How often do you hear the expression “That’s so gay‚” or “You’re so gay” in school?
Frequently‚ Often‚ Sometimes‚ Rarely‚ Never
2. How often have you heard other homophobic remarks used in school (such as “faggot‚” “dyke‚” and “queer” used in a derogatory manner)?
Frequently‚ Often‚ Sometimes‚ Rarely‚ Never
3. How often do you hear these homophobic remarks from other students?
Frequently‚ Often‚ Sometimes‚ Rarely‚ Never
4. Would you say that homophobic remarks are made by:
Most of the students‚ Some of the students‚ Some of the students
5. How often do you hear these homophobic remarks from teachers or school staff?
Frequently‚ Often‚ Sometimes‚ Rarely‚ Never
6. In general‚ how much has it bothered or distressed you when you’ve heard words like “gay” or “queer” used to describe something in a derogatory way‚ like “That class was so gay”?
Not at all‚ A little‚ Pretty much‚ Extremely
7. When you hear homophobic remarks‚ how often has a teacher or other school staff person been present?
Always‚ Most of the time‚ Some of the time‚ Never (Go to 9)
8. When homophobic remarks are made and a teacher or other school staff person is present‚ how often does the teacher or staff person intervene?
Always‚ Most of the time‚ Some of the time‚ Never
9. When you hear homophobic remarks‚ how often does another student intervene?
Always‚ Most of the time‚ Some of the time‚ Never
SECTION B
This next set of questions is about racist remarks you may have heard at your school. Please circle the answer that best describes your experience at your school.
1. How often have you heard racist remarks used in school (such as “nigger‚” “kike‚” “spic‚” “gook‚” used in a derogatory manner)?
Frequently‚ Often‚ Sometimes‚ Rarely‚ Never
2. How often do you hear racist remarks from other students?
Frequently‚ Often‚ Sometimes‚ Rarely‚ Never
3. Would you say that racist remarks are made by:
Most of the students‚ Some of the students‚ Some of the students
4. How often do you hear racist remarks from teachers or school staff?
Frequently‚ Often‚ Sometimes‚ Rarely‚ Never
5. When you hear racist remarks‚ how often has a teacher or other school staff personbeen present?
Always‚ Most of the time‚ Some of the time‚ Never (Go to 7)
6. When racist remarks are made and a teacher or other school staff person is present‚how often does the teacher or staff person intervene?
Always‚ Most of the time‚ Some of the time‚ Never
7. When you hear racist remarks‚ how often does another student intervene?
Always‚ Most of the time‚ Some of the time‚ Never
SECTION C
This set of questions is about sexist remarks you may have heard at your school. Please circle the answer that best describes your experience at your school.
1. How often have you heard sexist remarks used in school (such as someone being called a “bitch” in a derogatory way or comments about girls’ bodies or talk of girls being inferior to boys)?
Frequently‚ Often‚ Sometimes‚ Rarely‚ Never
2. How often do you hear sexist remarks from other students?
Frequently‚ Often‚ Sometimes‚ Rarely‚ Never
3. Would you say that sexist remarks are made by:
Most of the students‚ Some of the students‚ A few of the students
4. How often do you hear sexist remarks from teachers or school staff?
Frequently‚ Often‚ Sometimes‚ Rarely‚ Never
5. When you hear sexist remarks‚ how often has a teacher or other school staff person been present?
Always‚ Most of the time‚ Some of the time‚ Never (Go to 7)
6. When sexist remarks are made and a teacher or other school staff person is present‚how often does the teacher or staff person intervene?
Always‚ Most of the time‚ Some of the time‚ Never
7. When you hear sexist remarks‚ how often does another student intervene?
Always‚ Most of the time‚ Some of the time‚ Never
SECTION D
This set of questions is about remarks you may have heard at your school related to people’s gender expression. Please circle the answer that best describes your experience at your school.
1. How often have you heard comments about students not acting “masculine” enough?
Frequently‚ Often‚ Sometimes‚ Rarely‚ Never
2. How often have you heard comments about students not acting “feminine” enough?
Frequently‚ Often‚ Sometimes‚ Rarely‚ Never
3. How often do you hear these remarks from other students?
Frequently‚ Often‚ Sometimes‚ Rarely‚ Never
4. Would you say that these remarks are made by:
Most of the students‚ Some of the students‚ A few of the students
5. How often do you hear these remarks from teachers or school staff?
Frequently‚ Often‚ Sometimes‚ Rarely‚ Never
6. When you hear sexist remarks‚ how often has a teacher or other school staff person been present?
Always‚ Most of the time‚ Some of the time‚ Never (Go to 8)
7. When these remarks are made and a teacher or other school staff person is present‚ how often does the teacher or staff person intervene?
Always‚ Most of the time‚ Some of the time‚ Never
8. When you hear these remarks‚ how often does another student intervene?
Always‚ Most of the time‚ Some of the time‚ Never
SECTION E
This set of questions is about harassment or fights that you may have encountered at your school. For each question‚ please circle or check the answer that best describes your experience at your school.
1. In the last month of school‚ how many times did you skip a class because you felt uncomfortable or unsafe in that class?
0 times‚ 1 time‚ 2 or 3 times‚ 4 or 5 times‚ 6 or more times
2. In the last month of school‚ how many days did you not go to school because you felt uncomfortable or unsafe at school or on your way to or from school?
0 times‚ 1 time‚ 2 or 3 times‚ 4 or 5 times‚ 6 or more times
3. Do you feel unsafe at your school because of… (check all that apply)
 your sexual orientation
 your disability or because people think you have a disability
 your gender
 your religion or because people think you are of a certain religion
 your race or ethnicity
 how you express your gender (how traditionally “masculine” or “feminine” you are in your appearance or in how you act)
4. In the past year‚ how often have you been verbally harassed (name calling‚ threats‚ etc.) at your school because of…
a. your sexual orientation? Frequently‚ Often‚ Sometimes‚ Rarely‚ Never
b. your gender? Frequently‚ Often‚ Sometimes‚ Rarely‚ Never
c. how you express your gender? Frequently‚ Often‚ Sometimes‚ Rarely‚ Never
d. your race or ethnicity? Frequently‚ Often‚ Sometimes‚ Rarely‚ Never
e. your disability or because people think you have a disability? Frequently‚ Often‚ Sometimes‚ Rarely‚ Never
f. your religion or because people think you are of a certain religion? Frequently‚ Often Sometimes‚ Rarely‚ Never
5. In the past year‚ how often have you been physically harassed (shoved‚ pushed‚ etc.) at your school because of…
a. your sexual orientation? Frequently‚ Often‚ Sometimes‚ Rarely‚ Never
b. your gender? Frequently‚ Often‚ Sometimes‚ Rarely‚ Never
c. how you express your gender? Frequently‚ Often‚ Sometimes‚ Rarely‚ Never
d. your race or ethnicity? Frequently‚ Often‚ Sometimes‚ Rarely‚ Never
e. your disability or because people think you have a disability? Frequently‚ Often‚ Sometimes‚ Rarely‚ Never
f. your religion or because people think you are of a certain religion? Frequently‚ Often‚ Sometimes‚ Rarely‚ Never
6. In the past year‚ how often have you been physically assaulted (punched‚ kicked‚ injured with a weapon) at your school because of…
a. your sexual orientation? Frequently‚ Often‚ Sometimes‚ Rarely‚ Never
b. your gender? Frequently‚ Often‚ Sometimes‚ Rarely‚ Never
c. how you express your gender? Frequently‚ Often‚ Sometimes‚ Rarely‚ Never
d. your race or ethnicity? Frequently‚ Often‚ Sometimes‚ Rarely‚ Never
e. your disability or because people think you have a disability? Frequently‚ Often‚ Sometimes‚ Rarely‚ Never
f. your religion or because people think you are of a certain religion? Frequently‚ Often‚ Sometimes‚ Rarely‚ Never
7. How often have you been sexually harassed at your school‚ such as sexual remarks made toward you or someone touching your body inappropriately? Frequently‚ Often‚ Sometimes‚ Rarely‚ Never
8. In the past year‚ how often have you had mean rumors or lies spread about you in school? Frequently‚ Often‚ Sometimes‚ Rarely‚ Never
9. In the past year‚ how often have you had your property stolen or deliberately damaged‚ such as your car‚ clothing‚ or books in school? Frequently‚ Often‚ Sometimes‚ Rarely‚ Never
10. In the past year‚ how often have you received harassing or threatening emails‚ instant messages (IMs)‚ or text messages from students at your school? Frequently‚ Often‚ Sometimes‚ Rarely‚ Never
SECTION F
These next questions ask about who you talk to when you have experienced harassment or assault in your school‚ regardless of whether it was related to your sexual orientation‚ race/ethnicity‚ gender‚ or gender expression. If you have not experienced any incidents of harassment in school this past year‚ please skip to Section G.
1. How often did you report when you were harassed or assaulted in school to a teacher‚ the principal or other school staff person?
Always‚ Most of the time‚ Some of the time‚ Never (Go to 1c)
1a. How often did you report when you were harassed or assaulted in school to a teacher‚ the principal‚ or other school staff person? (Please answer in the space below):
….. …..
1b. Overall‚ how effective were the teachers or school staff in addressing the problems?
Very effective‚ Somewhat effective‚ Somewhat ineffective‚ Not at all effective
1c. Why did you NOT report being harassed or assaulted to a teacher or staff person? (Please answer in the space below):
…… ……
2. How often did you tell a parent or guardian when you were harassed or assaulted in school?
Always‚ Most of the time‚ Some of the time‚ Never (Go to 4)
3. How often did your parent or guardian talk to your teacher‚ principal‚ or other school staff because you had been harassed or assaulted in school?
Always‚ Most of the time‚ Some of the time‚ Never
4. How often did you tell another family member‚ other than your parent or guardian‚ when you were harassed or assaulted in school?
Always‚ Most of the time‚ Some of the time‚ Never (Go to Section G)
5. How often did another family member (besides your parent or guardian) talk to your teacher‚ principal‚ or other school staff because you had been harassed or assaulted in school?
Always‚ Most of the time‚ Some of the time‚ Never
SECTION G
This next set of questions is about some ch‎aracteristics of your school. If you no longer attend school (for instance‚ if you have graduated or have stopped going to school)‚ please answer the questions about the last school you attended in this school year.
1. Is your school… (check the box next to the best answer)
 a public school
If it is a public school: Is it a ch‎arter school?  Yes  No  Not Sure
Is it a magnet school?  Yes  No  Not Sure
 a religious-affiliated school  Catholic  Jewish
If it is a religious-affiliated school‚  Episcopal  Lutheran
please check which religion   Friends  Muslim  Christian Non- denominational  Other religion ….. …..
 another kind of non-public‚ private‚ or independent school
2. Where is your school? State ….. …..  School District ….. ……
(If you attended a non-public school‚ please list the name of the school district you live in.)
3. Is your school in a:
 Large city (pop’n over 250‚000)
 Mid-size city (pop’n under 250‚000)
 Suburb of a large city
 Suburb of a mid-size city
 Town (not a major metropolitan area)
 Rural area
4. Is your school a:
 K through 12 school  Elementary school  Lower school (elementary and middle school grades)  Middle school  Upper school (middle and high school grades)  High school
5. Does your school have a policy or a procedure for reporting incidents of harassment or assault in school?  Yes  No  Don’t know
5a. Does this policy specifically mention sexual orientation?  Yes  No  Not Sure
5b. Does this policy specifically mention gender identity/expression?  Yes  No  Not Sure
6. In the current school year‚ were you taught about lesbian‚ gay‚ bisexual‚ or transgender (LGBT) people‚ history‚ or events in any of your classes?
 No (Go to 7)
 Yes If yes‚ please check which classes (check as many as apply)
 History/Social Studies  Foreign Language  Science  Music  Health  Math  Gym/Physical Education  Art  English  Other ….. …..
6a. Overall‚ in those classes where LGBT topics were taught‚ do you think the representations of LGBT people‚ history‚ or events were:
 Very positive  Somewhat positive  Somewhat negative  Very negative
7. In your school health classes‚ was discussion about sexual orientation ever included‚ such as in discussions of dating‚ sexuality/sex education‚ or family relationships?
 Yes  No  Don’t know  Not applicable
7a. How positive or negative were representations of LGBT people?
 Very positive  Somewhat positive  Somewhat negative  Very negative
7b. In your school health classes‚ does your school follow an “abstinence-only” curriculum when teaching sexuality/sex education? For example‚ were you taught that you are expected to wait until marriage to engage in sexual activity‚ or that sexual activity outside of marriage is likely to have harmful effects on you?
 Yes  No  Don’t know  Not applicable
8. Do any of your textbooks contain information about LGBT people‚ history‚ or events?
 Yes  No  Don’t know
9. Are there books or other resources in your school library that contain information about LGBT people‚ history‚ or events?
 Yes  No  Don’t know
10. Are you able to use school computers to access websites about LGBT people‚ history‚ or events?
 Yes  No  Don’t know  Don’t have internet access at my school
11. Does your school have a Gay/Straight Alliance (GSA) or another type of club that addresses LGBT student issues?
 Yes  No (Go to 13)
12. How often do you attend GSA meetings?
 Frequently  Often  Sometimes  Rarely  Never
12a. Have you participated as a leader or officer of your GSA?
 Yes  No  Not applicable
12b. How supportive is your principal or other head school official of your school’s GSA?
 Very Supportive  Somewhat Supportive  Neutral  Somewhat Unsupportive  Very Unsupportive
12c. What activities has your GSA done during this school year?
(Please check all that apply)
 Organized social activities for its members.
 cr‎eated a supportive environment where members could talk about unique challenges some LGBT people face.
 Worked with teachers or school officials to reduce anti-LGBT bullying and harassment‚ including conducting teacher-trainings.
 Gave members the opportunity to make friends with LGBT students and allies.
 Helped members cope with anti-LGBT name calling‚ bullying‚ and harassment.
 Worked with teachers or school officials to increase representation of important LGBT people‚ events‚ or history in classes.
 Advocated with a teacher or school administrator on behalf of an LGBT student who was being bullied or harassed in school.
 Combated other types of social injustices‚ such as racism and sexism.
 Helped members to develop leadership skills for creating safer skills.
 Raised awareness of anti-LGBT harassment in your school and in society.
 Organized a school-wide event to raise awareness about LGBT issues‚ such as an assembly.
 Organized other types of awareness activities such as writing a school newspaper article‚ distributing educational materials‚ or raising money for an LGBT ch‎arity or cause.
 Other (please specify in the space below): ….. …..
13. How often do you attend a program or group for LGBT youth outside of your school?
 Frequently  Often  Sometimes  Rarely  Never
14. How many teachers or other school staff persons are supportive of LGBT students at your school?
 None  One  Between 2 and 5  Between 6 and 10  More than 10
15. How many teachers or other school staff at your school are open about being lesbian‚ gay‚ bisexual‚ or transgender?
 None  One  Between 2 and 5  Between 6 and 10  More than 10
16. Besides yourself‚ how many other LGBT students are there in your school that you know of?
 None  One  Between 2 and 5  Between 6 and 10  More than 10
17. In general‚ how supportive do you think people in your community are of LGBT people?
 Very Supportive  Somewhat Supportive  Neutral  Somewhat Unsupportive  Very Unsupportive
18. For each of the following types of school staff‚ please indicate how many times you have talked with each one about LGBT issues in this school year. Then‚ for each person you have talked to‚ please indicate how positive or negative the interaction was. (If there is more than one of a certain category you have talked to about LGBT issues‚ such as more than one teacher‚ answer for the one with whom you have had the most contact.)
18a. Teacher
 None (Go to b)   One time  Between 2 and 5  Between 6 and 10  More than 10
Overall‚ how positive were these interactions?
 Very Positive  Somewhat Positive  Somewhat Negative  Very Negative  Had no interaction about LGBT issues
18b. Principal
 None (Go to c)   One time  Between 2 and 5  Between 6 and 10  More than 10
Overall‚ how positive were these interactions?
 Very Positive  Somewhat Positive  Somewhat Negative  Very Negative  Had no interaction about LGBT issues
18c. School counselor or psychologist
 None (Go to d)  One time  Between 2 and 5  Between 6 and 10  More than 10
Overall‚ how positive were these interactions?
• Very Positive • Somewhat Positive • Somewhat Negative • Very Negative • Had no interaction about LGBT issues
18d. Coach (or other sports person) at school
 None(Go to e)   One time  Between 2 and 5 Between 6 and 10  More than 10
Overall‚ how positive were these interactions?
 Very Positive  Somewhat Positive  Somewhat Negative  Very Negative  Had no interaction about LGBT issues
18e. Nurse
 None (Go to e) One time • Between 2 and 5• Between 6 and 10 • More than 10
Overall‚ how positive were these interactions?
• Very Positive • Somewhat Positive • Somewhat Negative • Very Negative • Had no interaction about LGBT issues
18f. Librarian or other resource staff person
• None (Go to e)• One time • Between 2 and 5• Between 6 and 10 • More than 10
Overall‚ how positive were these interactions?
• Very Positive • Somewhat Positive • Somewhat Negative • Very Negative • Had no interaction about LGBT issues
SECTION H
The following section asks questions about your academic experiences and goals.
1. During the current school year how would you describe the grades you received in school?
 Mostly A’s  A’s and B’s  Mostly B’s  B’s and C’s
 Mostly C’s  C’s and D’s  Mostly D’s  Mostly F’s
2. What is the highest level of education you ever expect to complete?
 Less Than High School Graduation
 High School Graduation Only
Vocational‚ Trade‚ Or Technical School After High School
 Less than two years
 Two years or more
College Program
 Less than two years of college
 Two or more years of college (including two-year degree)
 Finish college (four- or five-year degree)
 ma‎ster’s degree or equivalent
 PhD‚ MD‚ or other advanced professional degree
Do you plan to go to college or university right after high school?
 Yes  No  Don’t know
Write in here the name of the job or occupation that you expect or plan to have when you are 30 years old. Even if you are not at all sure‚ write in your best guess. ….. ……
SECTION I
The next set of questions is about how comfortable you are at your school as an LGBT student.
1. In general‚ how comfortable would you be talking to your teachers‚ one-on-one‚ about LGBT issues?
 Very Comfortable  Somewhat Comfortable  Somewhat Uncomfortable  Very Uncomfortable
2. How comfortable would you be talking to your school principal about LGBT issues?
• Very Comfortable • Somewhat Comfortable • Somewhat Uncomfortable • Very Uncomfortable
3. How comfortable would you be talking to your school counselor or school psychologist about LGBT issues?
• Very Comfortable • Somewhat Comfortable • Somewhat Uncomfortable • Very Uncomfortable
4. How comfortable would you be talking to your school nurse about LGBT issues?
• Very Comfortable • Somewhat Comfortable • Somewhat Uncomfortable • Very Uncomfortable
5. How comfortable would you be talking to your school coach about LGBT issues?
• Very Comfortable • Somewhat Comfortable • Somewhat Uncomfortable • Very Uncomfortable
6. How comfortable would you be talking to your school librarian about LGBT issues?
• Very Comfortable • Somewhat Comfortable • Somewhat Uncomfortable • Very Uncomfortable
7. How many times have you raised LGBT issues in your classes?
 Never  Once  Between 2 and 5  More than 5 times
8. How comfortable would you be raising LGBT issues in your classes?
• Very Comfortable • Somewhat Comfortable • Somewhat Uncomfortable • Very Uncomfortable
SECTION J
This last section is about some of your personal ch‎aracteristics.
1. Below is a list of terms that people often use to describe their sexuality or sexual orientation. Please check all those terms that apply to you.
 Gay  Lesbian  Bisexual  Straight  Questioning
If none of these terms apply to you‚ please tell us how you describe your sexuality or sexual orientation: ….. …..
2. Below is a list of terms that people often use to describe their gender. Please check all those terms that apply to you.
 Male  Female  Transgender  Transgender Male-to-Female  Transgender Female-to-Male
If none of these terms apply to you‚ please tell us how you describe your sexuality or sexual orientation: ….. ……
3. Which of the following best describes how “out” you are at school about your being gay‚ lesbian‚ bisexual‚ transgender‚ or questioning?
I am “out” to everybody at school
I am “out” to most people at school
I am “out” only to a few people at school
I am not “out” to anyone at school
4. What is your race or ethnicity? Please check all those terms that apply to you.
Please check all those terms that apply to you.
White or European-American  African American or Black Hispanic or Latino/Latina Asian or
Pacific Islander  Native American  Other (please specify ….. …..
5. What percentage of the students in your school are the same race/ethnicity as you: …..%
6. Which of the following do you most closely identify as your religious affiliation or preference?
 Baptist  Buddhist  Catholic  Christian-Nondenominational  Eastern Orthodox  Episcopalian/Anglican  Hindu  Jehovah’s Witness  Jewish  Lutheran  Methodist  Mormon
 Muslim  Pentecostal/ch‎arismatic  Presbyterian  Seventh-Day Adventist  Unitarian/Universalist  None  Other….. …..
7. How old are you? …..
8. Did you attend school during this school year?
 Yes : 8a. What grade are you currently? ……
 No : 8b. When was the last time you attended school? …… Month‚ …… Year
9. What is your zip code? _________________ (format: 99999)
10. Did you participate in GLSEN’s 2003 National School Climate Survey?
 Yes  No  Not sure
This instrument can be found on pages 88-100 of Measuring Bullying Victimization‚ Perpetration‚ and BystanderExperiences:A Compendium of Assessment Tools‚ available online at: http://www.cdc.gov/violenceprevention/pdf/bullycompendiumbk-a.pdf

Kosciw‚ J. G.‚ & Diaz‚ E. M. (2006). The 2005 National School Climate Survey: The experiences of lesbian‚ gay‚ bisexual and transgender youth in our nation’s schools. New York: GLSEN.

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Tel: 212-727-0135