Parent Questionnaire
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The Prevent Assault and Violence Education (PAVE) program works to prevent violence through promoting healthy relationship building in our community. We would like to get your input on the issues related to this work so that we can better serve our community with our services. Your input will be used to assist us in planning our activities for the upcoming year. Please think of our town, school or family when filling out the items below. This questionnaire should take between 10 to 15 minutes to complete.

1. *Thinking about the adults in your community, please describe whether you believe the following challenges are not an issue, a minor issue, a moderate issue, or a major issue in your community.

	Not an Issue	Minor Issue	Moderate Issue	Major Issue
Sexual harassment in the workplace	**Thinking about the adults in your community, please describe whether you believe the following challenges are not an issue, a minor issue, a moderate issue, or a major issue in your community. Sexual harassment in the workplace Not an Issue	Sexual harassment in the workplace Minor Issue	Sexual harassment in the workplace Moderate Issue	Sexual harassment in the workplace Major Issue
Poor communication skills for spouses or partners	Poor communication skills for spouses or partners Not an Issue	Poor communication skills for spouses or partners Minor Issue	Poor communication skills for spouses or partners Moderate Issue	Poor communication skills for spouses or partners Major Issue
Verbal abuse between spouses or partners	Verbal abuse between spouses or partners Not an Issue	Verbal abuse between spouses or partners Minor Issue	Verbal abuse between spouses or partners Moderate Issue	Verbal abuse between spouses or partners Major Issue
Domestic violence	Domestic violence Not an Issue	Domestic violence Minor Issue	Domestic violence Moderate Issue	Domestic violence Major Issue
Rape or sexual Violence	Rape or sexual Violence Not an Issue	Rape or sexual Violence Minor Issue	Rape or sexual Violence Moderate Issue	Rape or sexual Violence Major Issue
Student safety on the way to and from school	Student safety on the way to and from school Not an Issue	Student safety on the way to and from school Minor Issue	Student safety on the way to and from school Moderate Issue	Student safety on the way to and from school Major Issue

2. *Thinking about your town or school district area, how likely is it that you or another adult would respond in these situations:

	Not at All Likely	Somewhat Likely	Very Likely
If a girl was being verbally harassed by a boy at the high school, how likely is it that a teacher or other adult would do something to stop it?	**Thinking about your town or school district area, how likely is it that you or another adult would respond in these situations: If a girl was being verbally harassed by a boy at the high school, how likely is it that a teacher or other adult would do something to stop it? Not at All Likely	If a girl was being verbally harassed by a boy at the high school, how likely is it that a teacher or other adult would do something to stop it? Somewhat Likely	If a girl was being verbally harassed by a boy at the high school, how likely is it that a teacher or other adult would do something to stop it? Very Likely
If you saw a child or teenager being bullied, how likely is it that you or another adult would attempt to stop it?	If you saw a child or teenager being bullied, how likely is it that you or another adult would attempt to stop it? Not at All Likely	If you saw a child or teenager being bullied, how likely is it that you or another adult would attempt to stop it? Somewhat Likely	If you saw a child or teenager being bullied, how likely is it that you or another adult would attempt to stop it? Very Likely
If you could hear a man and woman inside a house violently arguing and throwing things, how likely is it that you or someone else would call the police or 911?	If you could hear a man and woman inside a house violently arguing and throwing things, how likely is it that you or someone else would call the police or 911? Not at All Likely	If you could hear a man and woman inside a house violently arguing and throwing things, how likely is it that you or someone else would call the police or 911? Somewhat Likely	If you could hear a man and woman inside a house violently arguing and throwing things, how likely is it that you or someone else would call the police or 911? Very Likely
If an adult hit a child in the grocery store, how likely is it that you or someone else would do something, such as talk to the parent or call child protective services?	If an adult hit a child in the grocery store, how likely is it that you or someone else would do something, such as talk to the parent or call child protective services? Not at All Likely	If an adult hit a child in the grocery store, how likely is it that you or someone else would do something, such as talk to the parent or call child protective services? Somewhat Likely	If an adult hit a child in the grocery store, how likely is it that you or someone else would do something, such as talk to the parent or call child protective services? Very Likely
If you saw a teenage girl being physically threatened by her boyfriend, how likely is it that you or someone else would step in to do something to stop it?	If you saw a teenage girl being physically threatened by her boyfriend, how likely is it that you or someone else would step in to do something to stop it? Not at All Likely	If you saw a teenage girl being physically threatened by her boyfriend, how likely is it that you or someone else would step in to do something to stop it? Somewhat Likely	If you saw a teenage girl being physically threatened by her boyfriend, how likely is it that you or someone else would step in to do something to stop it? Very Likely

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Parent QuestionnaireExit this survey

1. *Thinking about the adults in your community, please describe whether you believe the following challenges are not an issue, a minor issue, a moderate issue, or a major issue in your community.

2. *Thinking about your town or school district area, how likely is it that you or another adult would respond in these situations:

Parent Questionnaire
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