Domestic Violence Survey
This survey is completely anonymous and your personal answers will not be connected to
any identifying information at any time. Your answers will only be used for statistical
data in regards to Carbon and Yellowstone County residents’ attitudes towards domestic
abuse. Do you agree that you are over age 18 and that you have read and understand
the information about this survey provided in the cover letter:
Yes __ No __
Gender: Male
Female
Age _____ County: Yellowstone
Carbon
Family Status: Married___ Single___ Divorced___ Other___
Do you have children: Yes___ No___
If Yes: Number of Children under age 10_____ over age 10_____
Has anyone you know ever been domestically abused? Yes ___ No ___
If yes, did you/they use the Domestic and Sexual Violence Services?
Yes ___ No ___
Are you aware of services available for domestically abused victims? Yes___ No___
Are you aware of services offered for victims of domestic violence by the Domestic and
Sexual Violence Services of Carbon County?
Yes ___ No ___
Are you aware of services offered for victims of domestic violence by the Billings
YWCA? Yes__ No___
On a scale of 1 to 5, one being strongly disagree and five strongly agree, please
answer the following statements.
Strongly
Strongly
Agree
1
Domestic abuse is a serious issue that our community
should focus on preventing:
Domestic violence should be settled within the family
rather than involving the police or government officials:
Domestic abuse is a serious crime and the abuser should
go to jail:
Neutral
2
3
Disagree
4
5
Physical, sexual, emotional, spiritual, and economic
abuse are all forms of domestic abuse:
There are no real victims of domestic abuse as we
all have choices and can leave at any time:
Some people provoke abuse and deserve it:
Domestic violence counseling and support services
are good ways to help victims of domestic violence:
Would you call it domestic violence for an intimate partner to:
Always
A. Deny household money to their partner
B. Yell at partner
C. Threaten the children
D. Threaten to harm pets
E. Smash household objects near
partner/family members.
F. Insult or demean partner in front of the
children
G. Insult or demean partner in front of others
at home
H. Insult or demean partner in front of others
in public
I. Isolate partner from others
Sometimes
Never
Please answer the following questions based on your personal preferences:
What type of media do you listen/watch the most?
___ Radio
___ Television
___ Newspapers
___ Internet
From your #1 ranking, what channel/station/site/magazine do you listen/watch/read the
most? _____________ (Example: Radio: Hot 101.9, TV: NBC, MTV, ESPN)
If you ranked radio or television as your #1 source of media, what time of day to you
listen/watch?
Early morning__
Afternoon____
Early Evening____
Late Night____