Domestic Violence-Women's Support Group (Fall 2026) Survey

Question Title

1. Contact Info (Required.)

Name

Address

City/Town

ZIP/Postal Code

Email Address

Phone Number

Question Title

2. Date of Birth (Required.)

Date of Birth

Date

Question Title

3. What is your ethnicity? (Required.)

American Indian or Alaska Native

Asian or Asian American

Black or African American

Hispanic or Latino

Middle Eastern or North African

Native Hawaiian or other Pacific Islander

White

Another race

Question Title

4. What do you hope to gain from this support group?

	Strongly Agree	Agree	Unsure	Disagree	Strongly Disagree
1. I understand the cycle of domestic violence and understand how the cycle is present in my relationship.	1. I understand the cycle of domestic violence and understand how the cycle is present in my relationship. Strongly Agree	1. I understand the cycle of domestic violence and understand how the cycle is present in my relationship. Agree	1. I understand the cycle of domestic violence and understand how the cycle is present in my relationship. Unsure	1. I understand the cycle of domestic violence and understand how the cycle is present in my relationship. Disagree	1. I understand the cycle of domestic violence and understand how the cycle is present in my relationship. Strongly Disagree
2. I am knowledgeable about how domestic violence affects my children and/or others in my life	2. I am knowledgeable about how domestic violence affects my children and/or others in my life Strongly Agree	2. I am knowledgeable about how domestic violence affects my children and/or others in my life Agree	2. I am knowledgeable about how domestic violence affects my children and/or others in my life Unsure	2. I am knowledgeable about how domestic violence affects my children and/or others in my life Disagree	2. I am knowledgeable about how domestic violence affects my children and/or others in my life Strongly Disagree
3. I am aware of resources available to me in regards to domestic violence.	3. I am aware of resources available to me in regards to domestic violence. Strongly Agree	3. I am aware of resources available to me in regards to domestic violence. Agree	3. I am aware of resources available to me in regards to domestic violence. Unsure	3. I am aware of resources available to me in regards to domestic violence. Disagree	3. I am aware of resources available to me in regards to domestic violence. Strongly Disagree
4. I currently have emotional support in dealing with the effects of domestic violence in my life.	4. I currently have emotional support in dealing with the effects of domestic violence in my life. Strongly Agree	4. I currently have emotional support in dealing with the effects of domestic violence in my life. Agree	4. I currently have emotional support in dealing with the effects of domestic violence in my life. Unsure	4. I currently have emotional support in dealing with the effects of domestic violence in my life. Disagree	4. I currently have emotional support in dealing with the effects of domestic violence in my life. Strongly Disagree
5. I am frustrated/angry with the abuse in my relationship.	5. I am frustrated/angry with the abuse in my relationship. Strongly Agree	5. I am frustrated/angry with the abuse in my relationship. Agree	5. I am frustrated/angry with the abuse in my relationship. Unsure	5. I am frustrated/angry with the abuse in my relationship. Disagree	5. I am frustrated/angry with the abuse in my relationship. Strongly Disagree
6. I understand that jealousy, control and intimidation are not components of a healthy and loving relationship.	6. I understand that jealousy, control and intimidation are not components of a healthy and loving relationship. Strongly Agree	6. I understand that jealousy, control and intimidation are not components of a healthy and loving relationship. Agree	6. I understand that jealousy, control and intimidation are not components of a healthy and loving relationship. Unsure	6. I understand that jealousy, control and intimidation are not components of a healthy and loving relationship. Disagree	6. I understand that jealousy, control and intimidation are not components of a healthy and loving relationship. Strongly Disagree
7. I feel confident I can protect myself and my children.	7. I feel confident I can protect myself and my children. Strongly Agree	7. I feel confident I can protect myself and my children. Agree	7. I feel confident I can protect myself and my children. Unsure	7. I feel confident I can protect myself and my children. Disagree	7. I feel confident I can protect myself and my children. Strongly Disagree
8. I have knowledge of the common traits of batterers/abusers and the “red flags” of an abusive relationship.	8. I have knowledge of the common traits of batterers/abusers and the “red flags” of an abusive relationship. Strongly Agree	8. I have knowledge of the common traits of batterers/abusers and the “red flags” of an abusive relationship. Agree	8. I have knowledge of the common traits of batterers/abusers and the “red flags” of an abusive relationship. Unsure	8. I have knowledge of the common traits of batterers/abusers and the “red flags” of an abusive relationship. Disagree	8. I have knowledge of the common traits of batterers/abusers and the “red flags” of an abusive relationship. Strongly Disagree

Strongly Agree

Agree

Unsure

Disagree

Strongly Disagree

1. I understand the cycle of domestic violence and understand how the cycle is present in my relationship.

1. I understand the cycle of domestic violence and understand how the cycle is present in my relationship. Strongly Agree

1. I understand the cycle of domestic violence and understand how the cycle is present in my relationship. Agree

1. I understand the cycle of domestic violence and understand how the cycle is present in my relationship. Unsure

1. I understand the cycle of domestic violence and understand how the cycle is present in my relationship. Disagree

1. I understand the cycle of domestic violence and understand how the cycle is present in my relationship. Strongly Disagree

2. I am knowledgeable about how domestic violence affects my children and/or others in my life

2. I am knowledgeable about how domestic violence affects my children and/or others in my life Strongly Agree

2. I am knowledgeable about how domestic violence affects my children and/or others in my life Agree

2. I am knowledgeable about how domestic violence affects my children and/or others in my life Unsure

2. I am knowledgeable about how domestic violence affects my children and/or others in my life Disagree

2. I am knowledgeable about how domestic violence affects my children and/or others in my life Strongly Disagree

3. I am aware of resources available to me in regards to domestic violence.

3. I am aware of resources available to me in regards to domestic violence. Strongly Agree

3. I am aware of resources available to me in regards to domestic violence. Agree

3. I am aware of resources available to me in regards to domestic violence. Unsure

3. I am aware of resources available to me in regards to domestic violence. Disagree

3. I am aware of resources available to me in regards to domestic violence. Strongly Disagree

4. I currently have emotional support in dealing with the effects of domestic violence in my life.

4. I currently have emotional support in dealing with the effects of domestic violence in my life. Strongly Agree

4. I currently have emotional support in dealing with the effects of domestic violence in my life. Agree

4. I currently have emotional support in dealing with the effects of domestic violence in my life. Unsure

4. I currently have emotional support in dealing with the effects of domestic violence in my life. Disagree

4. I currently have emotional support in dealing with the effects of domestic violence in my life. Strongly Disagree

5. I am frustrated/angry with the abuse in my relationship.

5. I am frustrated/angry with the abuse in my relationship. Strongly Agree

5. I am frustrated/angry with the abuse in my relationship. Agree

5. I am frustrated/angry with the abuse in my relationship. Unsure

5. I am frustrated/angry with the abuse in my relationship. Disagree

5. I am frustrated/angry with the abuse in my relationship. Strongly Disagree

6. I understand that jealousy, control and intimidation are not components of a healthy and loving relationship.

6. I understand that jealousy, control and intimidation are not components of a healthy and loving relationship. Strongly Agree

6. I understand that jealousy, control and intimidation are not components of a healthy and loving relationship. Agree

6. I understand that jealousy, control and intimidation are not components of a healthy and loving relationship. Unsure

6. I understand that jealousy, control and intimidation are not components of a healthy and loving relationship. Disagree

6. I understand that jealousy, control and intimidation are not components of a healthy and loving relationship. Strongly Disagree

7. I feel confident I can protect myself and my children.

7. I feel confident I can protect myself and my children. Strongly Agree

7. I feel confident I can protect myself and my children. Agree

7. I feel confident I can protect myself and my children. Unsure

7. I feel confident I can protect myself and my children. Disagree

7. I feel confident I can protect myself and my children. Strongly Disagree

8. I have knowledge of the common traits of batterers/abusers and the “red flags” of an abusive relationship.

8. I have knowledge of the common traits of batterers/abusers and the “red flags” of an abusive relationship. Strongly Agree

8. I have knowledge of the common traits of batterers/abusers and the “red flags” of an abusive relationship. Agree

8. I have knowledge of the common traits of batterers/abusers and the “red flags” of an abusive relationship. Unsure

8. I have knowledge of the common traits of batterers/abusers and the “red flags” of an abusive relationship. Disagree

8. I have knowledge of the common traits of batterers/abusers and the “red flags” of an abusive relationship. Strongly Disagree

Domestic Violence-Women's Support Group (Fall 2026)

Women's Support Group-Domestic Violence

Question Title

1. Contact Info (Required.)

Question Title

2. Date of Birth (Required.)

Question Title

3. What is your ethnicity? (Required.)

Question Title

4. What do you hope to gain from this support group?

Question Title

5. PLEASE RATE YOUR FEELINGS/THOUGHTS/KNOWLEDGE BY CHECKING THE APPROPRIATE RESPONSE FOR EACH OF THE FOLLOWING AREAS: (Required.)

Question Title

* 1. Contact Info (Required.)

Question Title

* 2. Date of Birth (Required.)

Question Title

* 3. What is your ethnicity? (Required.)

Question Title

* 4. What do you hope to gain from this support group?

Question Title

* 5. PLEASE RATE YOUR FEELINGS/THOUGHTS/KNOWLEDGE BY CHECKING THE APPROPRIATE RESPONSE FOR EACH OF THE FOLLOWING AREAS: (Required.)

1. Contact Info (Required.)

2. Date of Birth (Required.)

3. What is your ethnicity? (Required.)

4. What do you hope to gain from this support group?

5. PLEASE RATE YOUR FEELINGS/THOUGHTS/KNOWLEDGE BY CHECKING THE APPROPRIATE RESPONSE FOR EACH OF THE FOLLOWING AREAS: (Required.)