Student Health Services Knowledge

1. What is your age?

What is your age? 18-21

22-29

30 or over

2. What is your gender?

What is your gender? Woman

Man

Other

3. What is your race / ethnicity?

What is your race / ethnicity? Hispanic or Latino

Black or African-American

Asian or Pacific Islander

Middle Eastern

American Indian

Caucasian

Mixed race / ethnicity

Other (please specify)

4. What is your religious affiliation?

What is your religious affiliation? Jewish

Muslim

Christian

Buddhist

Hindu

Other (please specify)

5. What is your sexual orientation?

What is your sexual orientation? Asexual

Bisexual

Heterosexual

Homosexual

6. How aware are you of the following on campus:

	Very Aware	Somewhat Aware	Somewhat Unaware	Very Unaware
Health Services	How aware are you of the following on campus: Health Services Very Aware	Health Services Somewhat Aware	Health Services Somewhat Unaware	Health Services Very Unaware
Mental Health Services	Mental Health Services Very Aware	Mental Health Services Somewhat Aware	Mental Health Services Somewhat Unaware	Mental Health Services Very Unaware

Which services are you aware of?

7. Have you used any of the student health services on campus?

Have you used any of the student health services on campus? Yes

If yes, which ones?

8. Are you aware of on-campus services offered for victims of rape and/or domestic violence?

Are you aware of on-campus services offered for victims of rape and/or domestic violence? Yes

If yes, which ones?

9. Have you ever sought help on campus for the following:

	Yes	No
Immunizations	Have you ever sought help on campus for the following: Immunizations Yes	Immunizations No
Basic Healthcare (cold and flu)	Basic Healthcare (cold and flu) Yes	Basic Healthcare (cold and flu) No
Sexual Health	Sexual Health Yes	Sexual Health No
Rape	Rape Yes	Rape No
Domestic Violence	Domestic Violence Yes	Domestic Violence No

If you answered yes to any of the above, what kinds of services did you receive?

10. Would you use any of the following health services on campus:

	Yes	No
Immunizations	Would you use any of the following health services on campus: Immunizations Yes	Immunizations No
Basic Healthcare (cold and flu)	Basic Healthcare (cold and flu) Yes	Basic Healthcare (cold and flu) No
Sexual Health	Sexual Health Yes	Sexual Health No
Rape	Rape Yes	Rape No
Domestic Violence	Domestic Violence Yes	Domestic Violence No

If no, why not?

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