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Copyright Malvin Porter, Jr. 2010 - acumen - The University of ...

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 Asian American<br />

 European American / White<br />

 Other<br />

3. How old are you today?  8 years old<br />

 9 years old<br />

 10 years old<br />

 11 years old<br />

 12 years old<br />

4. When were you born? ___________Month _____Day __________Year<br />

5. What is the primary language that you speak at home?<br />

 English<br />

 Spanish<br />

 German<br />

 Other<br />

6. Who lives with you in your house? (Check all that apply)<br />

 Mom<br />

 Dad<br />

 Step-mom<br />

 Step-dad<br />

 Grandparent<br />

 Aunts / Uncles / Other family members<br />

 Brothers<br />

 Sisters<br />

 Step Brothers<br />

 Step Sisters<br />

7. How many people live in you house?<br />

 2  3  4  5  6  7  8  9  10 or more<br />

Story 1. Josh’s Story [ Bystander – Physical bullying ]<br />

Josh is the main character in this story. He watches as mean kids pick on Charlie.<br />

Charlie, who is small for his age, is just like most other boys in his school.<br />

Charlie gets picked on every day by some bigger kids. Charlie <strong>of</strong>ten gets pushed or bumped on<br />

purpose while waiting in the class lines. Once when the teacher was busy with another<br />

student, a mean kid poked Charlie with a sharp pencil. It really hurt. Another time after<br />

school, Charlie was tripped so hard that he fell down and tore his shirt. <strong>The</strong> mean kids think it<br />

is fun to pick on Charlie.<br />

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