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1. Please include agency name, email, contact person and number.

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2. How much of a problem do you think sexual violence is in our community?

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3. Does your agency have a protocol in place about procedures to follow when sexual assault is reported or suspected?

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4. Does your agency have specific policies, programs, or resources in place for sexual assault victims who are: (Check all that apply.)

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5. Is there sexual assault literature available at your agency?

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6. If yes:
Are any of these materials available in Spanish?

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7. Do any of your agency staff get training about sexual assault?

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8. What are the strengths of the system responding to sexual violence cases in our community?

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9. What are the gaps in the system responding to sexual violence cases in our community?

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