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* 1. What year in school are you?

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* 2. What’s your gender?

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* 3. What religion do you identify with?

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* 4. How important is your religious/spiritual life?

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* 5. How old were you when you first saw pornography (sexually explicit nude pictures or videos)?

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* 6. Have you sent or received a sexually explicit or nude photo via text?

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* 7. What best describes the frequency of your pornography consumption (sexually explicit nude pictures or videos)?

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* 8. Have you made efforts to stop or cut back on your porn use?

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* 9. Has your porn use or the inability to stop it caused you to doubt your faith?

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* 10. Has your porn use negatively impacted any of your relationships (ie. isolating from certain relationships)?

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* 11. Has your porn use decreased your desire to serve in a spiritual capacity (church service, leadership role, ministry activities)?

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* 12. Has your porn use decreased your desire to read or study God’s word?

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* 13. Have you shared with someone else about your struggle with pornography?

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* 14. Do you experience self-hatred after watching porn?

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* 15. Has your porn use hindered your academic or extracurricular participation or performance?

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* 16. Has porn been your primary educator on sex?

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* 17. Would you consider yourself addicted to pornography?

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* 18. Have you had suicidal thoughts due to your porn use?

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* 19. Do you wish you could quit your porn habit?

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* 20. Do you wish you had never seen porn?

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