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1.
Attendance Information:
First & Last Name
Email Address
2.
Grade
9th
10th
11th
12th
Teacher / Staff
Parent
Other (please specify)
*
3.
Due to today's program, I am more likely to ASK FIRST before engaging in sexual intimacy with a partner.
(Required.)
Strongly Agree
Agree
Neither Agree or Disagree
Disagree
Strongly Disagree
*
4.
I am now more likely to STOP someone from using alcohol to sexual assault another person.
(Required.)
Strongly Agree
Agree
Neither Agree or Disagree
Disagree
Strongly Disagree
*
5.
I am now more likely to tell loved ones that I am here for them if anyone ever sexually assaults them.
(Required.)
Strongly Agree
Agree
Neither Agree or Disagree
Disagree
Strongly Disagree
6.
What are you going to use from today's program?
7.
How would you describe this session to someone who wasn't here?
8.
What would you like to say to Mike or ask Mike? Questions are often about relationships, consent, sexual intimacy, bystander intervention, or supporting survivors. Mike often answers your questions on his
YouTube channel (CenterForRespect)
and on
Instagram (@MikeRespects)
. Subscribe to his
YouTube
and follow him on
Instagram
to watch for your question to be answered.
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