THE GUTS TO BE GOOD Project Survey

1. Hello, Thank you for taking this survey. You have been selected to help design, implement and evaluate a video project focusing on positive solutions to prevent sexual violence before it begins. The Arizona Department of Health Services, Our Family in Tucson and Peer Solutions in Phoenix/Tempe are working together to help you with this project. Please take a few minutes to answer the following questions. We will use your results to help define next steps.

Hello, Thank you for taking this survey. You have been selected to help design, implement and evaluate a video project focusing on positive solutions to prevent sexual violence before it begins. The Arizona Department of Health Services, Our Family in Tucson and Peer Solutions in Phoenix/Tempe are working together to help you with this project. Please take a few minutes to answer the following questions. We will use your results to help define next steps. Name
School/Organization
Year in School If applicable
City you live in
Email
Phone
Are you on Facebook?

2. On a scale of 1-4, 1 (the first circle) being “a very great concern” and 4 (the last circle)being “not a concern”, please click on the circle that best describes how much of a concern you think each issue is affecting your community?

	A very great concern	A great concern	A concern	Not a concern
Sexual Violence	*On a scale of 1-4, 1 (the first circle) being “a very great concern” and 4 (the last circle)being “not a concern”, please click on the circle that best describes how much of a concern you think each issue is affecting your community? Sexual Violence A very great concern	Sexual Violence A great concern	Sexual Violence A concern	Sexual Violence Not a concern
Bullying	Bullying A very great concern	Bullying A great concern	Bullying A concern	Bullying Not a concern
Child Abuse	Child Abuse A very great concern	Child Abuse A great concern	Child Abuse A concern	Child Abuse Not a concern
Substance Abuse	Substance Abuse A very great concern	Substance Abuse A great concern	Substance Abuse A concern	Substance Abuse Not a concern
Suicide	Suicide A very great concern	Suicide A great concern	Suicide A concern	Suicide Not a concern
Gang/Gun Violence	Gang/Gun Violence A very great concern	Gang/Gun Violence A great concern	Gang/Gun Violence A concern	Gang/Gun Violence Not a concern
Depression	Depression A very great concern	Depression A great concern	Depression A concern	Depression Not a concern
Eating Disorders	Eating Disorders A very great concern	Eating Disorders A great concern	Eating Disorders A concern	Eating Disorders Not a concern
Homelessness	Homelessness A very great concern	Homelessness A great concern	Homelessness A concern	Homelessness Not a concern
Harassment/Discrimination	Harassment/Discrimination A very great concern	Harassment/Discrimination A great concern	Harassment/Discrimination A concern	Harassment/Discrimination Not a concern
High School Drop Out Rates	High School Drop Out Rates A very great concern	High School Drop Out Rates A great concern	High School Drop Out Rates A concern	High School Drop Out Rates Not a concern

3. Please answer the following questions.

	Yes	Maybe	No	I dont know
Would you like to particpate in this video project?	* Please answer the following questions. Would you like to particpate in this video project? Yes	Would you like to particpate in this video project? Maybe	Would you like to particpate in this video project? No	Would you like to particpate in this video project? I dont know
Are you willing to meet with other students in Phoenix, Tucson and Casa Grande to make the video?	Are you willing to meet with other students in Phoenix, Tucson and Casa Grande to make the video? Yes	Are you willing to meet with other students in Phoenix, Tucson and Casa Grande to make the video? Maybe	Are you willing to meet with other students in Phoenix, Tucson and Casa Grande to make the video? No	Are you willing to meet with other students in Phoenix, Tucson and Casa Grande to make the video? I dont know
Are you willing to use humor to get the message across?	Are you willing to use humor to get the message across? Yes	Are you willing to use humor to get the message across? Maybe	Are you willing to use humor to get the message across? No	Are you willing to use humor to get the message across? I dont know

4. Please identify any concerns or barriers to participating in this project.

Please identify any concerns or barriers to participating in this project.

5. What are some areas that you would like to focus on your video project? (Please be specific: e.g. I would like to work on stereotyping/oppression)

What are some areas that you would like to focus on your video project? (Please be specific: e.g. I would like to work on stereotyping/oppression)

6. Do you think this video project is a good idea? Why or Why not?

Do you think this video project is a good idea? Why or Why not?

7. Please share any video project ideas you may already have. No need to hold back. All ideas very appreciated!

Please share any video project ideas you may already have. No need to hold back. All ideas very appreciated!

8. Are you part of a sexual violence prevention program?

Are you part of a sexual violence prevention program? Yes

Other

9. If you answered yes to question 8, what is the name of the sexual violence program you participate in. If OTHER: Please describe.

If you answered yes to question 8, what is the name of the sexual violence program you participate in. If OTHER: Please describe.

10. Anything else you would like to add?

Anything else you would like to add?

THE GUTS TO BE GOOD Project
Exit this survey

1. Default Section

THE GUTS TO BE GOOD ProjectExit this survey

1. Default Section

THE GUTS TO BE GOOD Project
Exit this survey