Awareness Walk Survey

WDVS Awareness Walk Survey

Thank you for participating & completing the following survey. The following questions are optional, as they may be sensitive. WDVS would like to inform participants that answers are confidential & only WDVS staff have access to the information. This survey is to give staff insight on what services would be helpful to offer to the community in reducing violence in Glenn County.

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* 1. What have you heard about Westside Domestic Violence Shelter?

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* 2. Has COVID-19 impacted your family relationships? If yes, please explain.

Yes

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* 3. Do you receive CalWorks?

Yes

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* 4. Have you lost your home due to a fire within the last 3 years?

Yes

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* 5. Have you ever experienced domestic violence?

Yes

Prefer not to answer

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* 6. Have you ever called a domestic violence agency for support? If yes, which agency? If no, why not?

Yes

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* 7. Have you experienced any of the following in a relationship? Choose all that apply.

Being called a mean name by a partner.

A partner controlling your finances.

A partner hurting your pets.

A partner physically hurting you.

A partner destroying any of your personal belongings.

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* 8. Have you ever experienced any of the following adverse childhood experiences (before the age of 18)? Choose all that apply.

A parent or adult insulting you, swearing at you, humiliating you, or act in a way that made you afraid you would be physically hurt?

A parent or adult pushing, grabbing, slapping, or throwing something at you?

Did an adult or person at least 5 years older than you touch or fondle you, or have you touch their body in a sexual way?

Did you often feel that no on in your family loved you or thought you were important or special?

Did you feel that you did not have enough to eat, had to wear dirty clothes, and had no one to protect you?

Did your parents separate or divorce?

Was your mother or stepmother ever pushed, grabbed, slapped or have something thrown at her?

Did you live with anyone who was a problem drinker alcoholic, or used street drugs?

Was a household member depressed, mentally ill, or attempt suicide?

Did a household member go to prison?

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* 9. Are you interested in volunteering, donating, or participating in events? Please check all that apply.

I would like to stay up to date on Westside Domestic Violence Shelter & what is happening in Glenn County around Domestic Violence prevention.

I am interested in learning more about domestic violence & attending education workshops.

I would like to volunteer with Westside Domestic Violence Shelter.

I have donations that could go to Westside Domestic Violence Shelter.

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* 10. As a thank you for completing this survey, Westside Domestic Violence Shelter has made limited gift bags for those interested. If you are interested in a gift bag or opportunities listed in the previous question, please provide your name, number & email to contact. (Optional). If you or someone you know is experiencing DV, please call/text our hotline (530) 865-4899.