Public Story Entry: Adult victims of school corporal punishment

Note: Fields marked with * are required.

First Name:

Last Name:

* Gender: Select One Male Female

* Ethnicity: Select One African American Asian Caucasian (White) Latino Native American Pacific Islander

* Email:

Phone:

May we contact you by phone? Yes No

May we contact you by email? Yes No

May we publish your story wherever we believe it will receive maximum support? Yes No

Are you willing to be interviewed by the media? (You can remain anonomous) Yes No
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Name of School:

Name of School District:

* U S State: Select One Alabama Alaska Arizona Arkansas California Colorado Connecticut Deleware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Virginia Washington West Virginia Wisconsin Wyoming

Territory:

* How old where you at the time of the paddling?

* What grade where you in at the time of the paddling? Select One 1st grade 2nd grade 2nd grade 2nd grade 3nd grade 4th grade 5th grade 6th grade 7th grade 8th grade 9th grade 10th grade 11th grade 12th grade

* About how much time went by between your learning that you would be paddled and the time the paddling took place? Select One That very moment Within the same day The next day 2 days after 3 days after 4 days after 5 days after 6 days after 7 days after more than a week

How many times were you paddled in one year?

1. School Year : - no. times 1 2 3 4 5 6 7 8 9 10 >

2. School Year : - no. times 1 2 3 4 5 6 7 8 9 10 >

3. School Year : - no. times 1 2 3 4 5 6 7 8 9 10 >

4. School Year : - no. times 1 2 3 4 5 6 7 8 9 10 >

* Where did the paddling take place? Select One Principal's Office Classroom Hallway Gymnasium Outside of the school In View of Other Students

* Who paddled you? Select One Principal Assistant Principal Coach Gym Teacher One of My Teachers A Faculty Member Bus Driver Other

* Name of the paddler (indicate Ms. Mr.):

* Did the paddler place their hands on your body or touch any part of your clothing prior to the paddling? Select One Yes No

If yes, where were you touched?

* How many times were you struck with the paddle? Select One 1 time 2 times 3 times 4 times 5 times 6 times 7 or more times

For what reason where you paddled?

* What was told to you by the paddler beforehand?

* What was told to you by the paddler afterwards?

* Had your parents/guardians submitted a signed note permitting the school to paddle you? Select One Yes No

* Were your parents/guardians warned prior to the paddling? Select One Yes No

* If your parents/guardians did not submit a note permitting the paddling, what was their response to it once it took place?

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* Was there a witness present during the paddling? Select One Yes No

If yes, who was the witness? Select One Principal Assistant Principal Coach Gym Teacher One of My Teachers A Faculty Member Bus Driver

Name of the witness (indicate Ms. Mr.):

Did the witness strike you also? Select One Yes No

* Have you told others about the paddling? Select One Yes No

* In what way were those who you told about the paddling helpful or not helpful at all?

Please limit your story to 500 words.