Student Questionnaire
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The Prevent Assault & 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 assist us in planning our activities for the upcoming year. Your responses will remain anonymous meaning we will not in any way link your identification with your responses. The questionnaire should take between 3 to 5 minutes to complete.

1. *Do you believe the following concerns are not an issue, a minor issue, a moderate issue or a major issue in your school or community? (Mark only one response per problem).

	Not an Issue	Minor Issue	Moderate Issue	Major Issue
Bullying	**Do you believe the following concerns are not an issue, a minor issue, a moderate issue or a major issue in your school or community? (Mark only one response per problem). Bullying Not an Issue	Bullying Minor Issue	Bullying Moderate Issue	Bullying Major Issue
Sexual harassment in school	Sexual harassment in school Not an Issue	Sexual harassment in school Minor Issue	Sexual harassment in school Moderate Issue	Sexual harassment in school Major Issue
Teen dating violence (abuse between boyfriends/girlfriends)	Teen dating violence (abuse between boyfriends/girlfriends) Not an Issue	Teen dating violence (abuse between boyfriends/girlfriends) Minor Issue	Teen dating violence (abuse between boyfriends/girlfriends) Moderate Issue	Teen dating violence (abuse between boyfriends/girlfriends) Major Issue
Sex and violence in the media (movies, TV, music, video games, magazines)	Sex and violence in the media (movies, TV, music, video games, magazines) Not an Issue	Sex and violence in the media (movies, TV, music, video games, magazines) Minor Issue	Sex and violence in the media (movies, TV, music, video games, magazines) Moderate Issue	Sex and violence in the media (movies, TV, music, video games, magazines) 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
“Cyber-stalking,” inappropriate cell phone messages/photos/texting, or other harmful use of technology to harass someone	“Cyber-stalking,” inappropriate cell phone messages/photos/texting, or other harmful use of technology to harass someone Not an Issue	“Cyber-stalking,” inappropriate cell phone messages/photos/texting, or other harmful use of technology to harass someone Minor Issue	“Cyber-stalking,” inappropriate cell phone messages/photos/texting, or other harmful use of technology to harass someone Moderate Issue	“Cyber-stalking,” inappropriate cell phone messages/photos/texting, or other harmful use of technology to harass someone Major Issue
Sexual abuse or sexual violence such as rape	Sexual abuse or sexual violence such as rape Not an Issue	Sexual abuse or sexual violence such as rape Minor Issue	Sexual abuse or sexual violence such as rape Moderate Issue	Sexual abuse or sexual violence such as rape Major Issue
The way women are portrayed in advertising and other media	The way women are portrayed in advertising and other media Not an Issue	The way women are portrayed in advertising and other media Minor Issue	The way women are portrayed in advertising and other media Moderate Issue	The way women are portrayed in advertising and other media Major Issue
The way men are portrayed in advertising and other media	The way men are portrayed in advertising and other media Not an Issue	The way men are portrayed in advertising and other media Minor Issue	The way men are portrayed in advertising and other media Moderate Issue	The way men are portrayed in advertising and other media Major Issue

2. How likely is it that you or an adult would intervene in the following situations? (Mark only one response per question)

	Not at All Likely	Somewhat Likely	Very Likely
If a girl was being verbally harassed by a boy at school, how likely is it that you or an adult would do something to stop it?	*How likely is it that you or an adult would intervene in the following situations? (Mark only one response per question) If a girl was being verbally harassed by a boy at school, how likely is it that you or an adult would do something to stop it? Not at All Likely	If a girl was being verbally harassed by a boy at school, how likely is it that you or an adult would do something to stop it? Somewhat Likely	If a girl was being verbally harassed by a boy at school, how likely is it that you or an adult would do something to stop it? Very Likely
If you saw someone at school being bullied, how likely is it that you or an adult would attempt to stop it?	If you saw someone at school being bullied, how likely is it that you or an adult would attempt to stop it? Not at All Likely	If you saw someone at school being bullied, how likely is it that you or an adult would attempt to stop it? Somewhat Likely	If you saw someone at school being bullied, how likely is it that you or an adult would attempt to stop it? Very Likely
If a friend was being cyber-bullied that he/she would tell you?	If a friend was being cyber-bullied that he/she would tell you? Not at All Likely	If a friend was being cyber-bullied that he/she would tell you? Somewhat Likely	If a friend was being cyber-bullied that he/she would tell you? Very Likely
If you saw other students fighting that you would go to a teacher or other adult for help to break up the fight?	If you saw other students fighting that you would go to a teacher or other adult for help to break up the fight? Not at All Likely	If you saw other students fighting that you would go to a teacher or other adult for help to break up the fight? Somewhat Likely	If you saw other students fighting that you would go to a teacher or other adult for help to break up the fight? 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
If you noticed another student had inappropriate posters or pictures hanging on the inside of their locker you would encourage them to remove them?	If you noticed another student had inappropriate posters or pictures hanging on the inside of their locker you would encourage them to remove them? Not at All Likely	If you noticed another student had inappropriate posters or pictures hanging on the inside of their locker you would encourage them to remove them? Somewhat Likely	If you noticed another student had inappropriate posters or pictures hanging on the inside of their locker you would encourage them to remove them? Very Likely
If a friend confided in you that she/he was being physically abused, how likely is it that you would encourage them to get help?	If a friend confided in you that she/he was being physically abused, how likely is it that you would encourage them to get help? Not at All Likely	If a friend confided in you that she/he was being physically abused, how likely is it that you would encourage them to get help? Somewhat Likely	If a friend confided in you that she/he was being physically abused, how likely is it that you would encourage them to get help? Very Likely

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Student QuestionnaireExit this survey

1. *Do you believe the following concerns are not an issue, a minor issue, a moderate issue or a major issue in your school or community? (Mark only one response per problem).

2. How likely is it that you or an adult would intervene in the following situations? (Mark only one response per question)

Student Questionnaire
Exit this survey