Anonymous sexual assault survey
Have you or someone you know been sexually assaulted?
Yes
No
How do you identify yourself?
Female
Male
Chose not to say
We’re you underage at the time of the assault?
Yes
No
Does any unexpected touch make you uncomfortable?
Strongly Agree
Agree
Neither agree nor disagree
Disagree
Strongly Disagree
Does your past experience interfere with relationships between significant others?
Strongly agree
Agree
Neither agree nor disagree
Disagree
Strongly disagree
Have you developed any unhealthy coping mechanisms?
Strongly Agree
Agree
Neither agree nor disagree
Disagree
Strongly Disagree
Has your past experience interfered with your relationship with family or friends?
Strongly Agree
Agree
Neither agree nor disagree
Disagree
Strongly Disagree
Do you know where to go to get help in the case of being sexually assaulted?
Strongly Agree
Agree
Neither agree nor disagree
Disagree
Strongly Disagree
Does this experience cause any triggers?
Strongly Agree
Agree
Neither agree nor disagree
Disagree
Strongly Disagree
Do you suffer from PTSD, anxiety or depression?
Strongly Agree
Agree
Neither agree nor disagree
Disagree
Strongly Disagree
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