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* 1. Today's Date

Date
Time

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* 2. School

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* 3. Chosen Gender Identification

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* 4. Class Period

Please rate the following by circling words that best show your answer regarding the class you have just completed.

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* 5. In general, I understood the information that the teacher taught in this class.

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* 6. Do you feel what you learned in this class will help you effectively diffuse and respond to incidents of sexual harassment in the future?

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* 7. Do you feel that what you learned in this class will help you effectively diffuse and respond to incidents of bullying in the future?

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* 8. I am confident that I could use my voice forcefully in an uncomfortable situation.

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* 9. In general, I thought that the physical techniques were easy to learn.

The following questions are about how you felt before you took this specific class versus how you feel after taking this specific class. Please select the answer that best describes how you feel. 

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* 10. How important is your body language for helping you avoid trouble and staying safe?

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* 11. How important do you think using your voice is in avoiding trouble and staying safe?

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* 12. How important do you think taking a self-defense class is in keeping you safe?

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* 13. What were you favorite thing(s) about this class? (Example: Getting to yell, kicking, etc.)

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* 14. What were your least favorite thing(s) about this class? 

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* 15. What other comments, suggestions, or questions do you have about this class?

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