Survey

Low self-esteem: Do you have it?

Circle your age: 13        14         15         16         17

Circle your gender:  Male           Female

(1)  What do you think low self-esteem is?

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*Low self esteem- is associated with your emotions or the feelings of depression.*

(2)  What should be done about low self-esteem? (If you choose other, please state your answer.)

a)     Theropy      b) Just deal with it         c) Talk to someone        d) Other: ________________

(3)  Where do you think low slef-esteem comes from?

a)     Bullying      b) Home life      c) School          d) All of the above

(4)  Low self-esteem has a big impact on a student’s life. (circle one)

Strongly agree  Agree   Disagree Strongly Disagree

(5)  Which type of bullying has an effect on low self-esteem? (Check all that may apply)

Physical___                              Social______

Verbal___                                 Intimidation____

Indirect___                                Cyber____

(6)  How many people are affected by low self-esteem yearly?(check one)

___Hundreds ___Thousands ___Millions

(7)  Bullying takes a huge part in low self-esteem. (Circle One)

Strongly Agree Agree   Disagree   Strongly Disagree

(8)  Do you have low self-esteem or do you know someone that has low self-esteem? (circle one)

Yes      No        Not sure

(9)  Do you think that low self esteem is an issue in the united sates?

Yes      No        Not sure

(10)                What can be done to help indivisuals improve there low self-esteem.

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