2018-2019 BHR Post-Survey

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* 1. Date

Date

Date

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* 2. School

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* 3. Teacher

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* 4. Grade

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* 5. Please name one resource that can help people in unhealthy relationships.

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* 6. Describe one unhealthy relationship behavior.

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* 7. Describe one healthy relationship behavior.

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* 8. How do you define dating violence?

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* 9. How do you define stalking?

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* 10. How do you define sexual violence?

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* 11. How do you define human trafficking?

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* 12. Consent is . . .

If you ask someone and they don't say no

something the girl gives

freely given and reversible at any time

needed at the beginning of a relationship, for instance, if the couple is not dating or married yet.

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* 13. Name at least two important parts of consent.

1.

2.

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* 14. Should you get consent to touch another person if you're not trying to have sex- for instance, if you want to hold hands or hug?

Yes

No

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* 15. What is a helpful thing to say to a friend who tells you they’ve been sexually assaulted?

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* 16. What is the age of consent in Indiana?

14

15

16

17

18

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* 17. What is the legal age you can send or receive sexual pictures or messages in Indiana?

14

16

18

21

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* 18. INSTRUCTIONS: For each statement, circle the
number that best explains your ability, knowledge,
and/or confidence. This survey is anonymous and
helps us assess the impact of our program. You’ll
receive an identical survey at the end of the
program.

	Strongly Disagree	Disagree	Unsure	Agree	Strongly Agree
I can explain how gender stereotypes impact unhealthy relationships. (Recall: gender box or gender norms activity)	I can explain how gender stereotypes impact unhealthy relationships. (Recall: gender box or gender norms activity) Strongly Disagree	I can explain how gender stereotypes impact unhealthy relationships. (Recall: gender box or gender norms activity) Disagree	I can explain how gender stereotypes impact unhealthy relationships. (Recall: gender box or gender norms activity) Unsure	I can explain how gender stereotypes impact unhealthy relationships. (Recall: gender box or gender norms activity) Agree	I can explain how gender stereotypes impact unhealthy relationships. (Recall: gender box or gender norms activity) Strongly Agree
I feel confident communicating my boundaries. (Recall: boundaries survey activity)	I feel confident communicating my boundaries. (Recall: boundaries survey activity) Strongly Disagree	I feel confident communicating my boundaries. (Recall: boundaries survey activity) Disagree	I feel confident communicating my boundaries. (Recall: boundaries survey activity) Unsure	I feel confident communicating my boundaries. (Recall: boundaries survey activity) Agree	I feel confident communicating my boundaries. (Recall: boundaries survey activity) Strongly Agree
I feel confident respecting others’ boundaries. (Recall: boundaries survey activity)	I feel confident respecting others’ boundaries. (Recall: boundaries survey activity) Strongly Disagree	I feel confident respecting others’ boundaries. (Recall: boundaries survey activity) Disagree	I feel confident respecting others’ boundaries. (Recall: boundaries survey activity) Unsure	I feel confident respecting others’ boundaries. (Recall: boundaries survey activity) Agree	I feel confident respecting others’ boundaries. (Recall: boundaries survey activity) Strongly Agree
I feel confident intervening when someone is being harmed. (Recall 3 D’s activity or helping a friend scenarios)	I feel confident intervening when someone is being harmed. (Recall 3 D’s activity or helping a friend scenarios) Strongly Disagree	I feel confident intervening when someone is being harmed. (Recall 3 D’s activity or helping a friend scenarios) Disagree	I feel confident intervening when someone is being harmed. (Recall 3 D’s activity or helping a friend scenarios) Unsure	I feel confident intervening when someone is being harmed. (Recall 3 D’s activity or helping a friend scenarios) Agree	I feel confident intervening when someone is being harmed. (Recall 3 D’s activity or helping a friend scenarios) Strongly Agree

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* 19. Feedback:

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* 20. What is your gender? (Optional)

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* 21. What is your race? (Optional)

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* 22. What is your ethnicity? (Optional)