Haven Survey
This survey asks about your current beliefs, attitudes, and experiences. Remember that this survey is anonymous. None of the information you provide will be linked to you in any way. Your
Individual response to any question you’re asked in this course will never be identified with you or reported.
If there are questions you would prefer not to answer, you can choose to leave them blank, but we hope you’ll answer all questions as completely as you can. The Information you provide will help
us evaluate the effectiveness of the course.
1. To What extent do you agree with the following statements?
Explicit Verbal consent is the best way to make sure a person is okay with sexual activity.
I don’t think sexual assault is a significant problem on my campus.
I would say or do something if I heard someone using sexist language.
I genuinely feel sorry for victims of relationship violence.
I have a good understanding of the definitions of sexual assault.
It’s not sexual assault if both people have been drinking.
I can play a role in preventing relationship violence on my campus.
Physical abuse is the only form of relationship violence.
A person should never be blamed for being the victim of sexual assault.
I am confident in my ability to support a friend who has been sexually assaulted.
People who identify as gay, lesbian, bisexual, or transgender are also at risk of relationship violence.
Sexist jokes and language don’t contribute to relationship violence.
I would take action in a situation in which someone was trying to take advantage of another person sexually.
Most students at my school would take action if they saw someone trying to take advantage of another person sexually.
I would respect someone who intervened to prevent a sexual assault.
Most students at my school would respect someone who intervened to prevent a sexual assault.
I am aware of resources for relationship violence on my campus.
I can identify warning signs of abuse in dating relationships.
I would feel comfortable intervening if I witnessed abusive behavior.
Most students at my school would feel comfortable intervening if they witnessed abusive behavior.
The following questions ask about experiences of non-consensual or unwanted sexual contact. This information can be used to help create a safe, supportive community at your school.
If these questions are difficult or uncomfortable for you in any way, or if you would prefer not to answer them, you can choose to leave them blank. We also encourage you to seek out
support resources if needed (which are provided in this program).
In this survey, sexual contact means one (or more) of the following:
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Forced touching of a sexual nature
Oral sex
Sexual intercourse
Anal sex
This survey is the property of EverFi, Inc. It is for review purposes only. Any distribution, sharing or use, without the expressed consent of the Director of Research at EverFi, is strictly forbidden.
Haven Surveys 2014-2015
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Sexual penetration with a finger or object
2. In the past, someone pressured or forced me into sexual contact without my explicit consent (e.g., used physical force or threatened to physically harm you; manipulated you through lies,
threats, or pressure; took sexual advantage of you when you were significantly impaired or incapacitated by drugs/alcohol, etc.).
3. In the past, I pressured or forced someone into sexual contact without their explicit consent (e.g., used physical force or threatened to physically harm them; manipulated them through lies,
threats, or pressure; took sexual advantage of them when they were significantly impaired or incapacitated by drugs/alcohol, etc.).
4. I have experienced some form of abuse (verbal, physical, sexual, emotional, financial) or threats of abuse in a current or previous relationship.
5. I have experienced repeated and unwanted attention, harassment, or other form of contact from another person that has made me feel afraid.
NOTE: DEMOGRAPHIC QUESTIONS ARE ONLY INCLUDED IN SURVEY 1
6. What is your biological sex?
7. What is your current gender identity?
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8. Do you consider yourself to be:
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9. Choose one answer that best describes your race / ethnicity:
10. Are you a United States citizen?
11.
If you are not a United States Citizen, how many years have you lived in the United States?
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12. What best matches your current situation?
This survey is the property of EverFi, Inc. It is for review purposes only. Any distribution, sharing or use, without the expressed consent of the Director of Research at EverFi, is strictly forbidden.
Haven Surveys 2014-2015
13. What year of school are you entering (currently enrolled)?
14.
How old are you?
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15.
From what state did you graduate high school?
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16. Which Best describes your [current] Intended living arrangements for this year of college?
17. Are you currently a member of any of the of the following? Please check all that apply.
Fraternity or sorority
Volunteer /community service organization
Student religious group
Intercollegiate athletic team
Intramural or club athletic team
Health education group
Media organization (e.g., newspaper, radio, magazine)
Substance abuse prevention peer education group
Minority or ethnic organization
Political or social action group
Music or other performing arts group
18. Do you intend to be a member of any of the following while at college? Please Check all that apply.
Fraternity or sorority
Volunteer /community service organization
Student religious group
Intercollegiate athletic team
Intramural or club athletic team
Health education group
Media organization (e.g., newspaper, radio, magazine)
Substance abuse prevention peer education group
Minority or ethnic organization
Political or social action group
Music or other performing arts group
19. Describe the highest level of education reached by ANY of your primary caregivers (e.g. mother, father, parental guardian)
20. What is your intended (current) enrollment status?
21. Did you transfer, or are you transferring, to this institution this term?
22. With whom do you intend to live while at college? Please Check all that apply.
Alone
With 1 roommate
With 2 or more roommates
With parent(s)
With steady boyfriend/girlfriend, partner, or spouse
With child(ren)
Other
This survey is the property of EverFi, Inc. It is for review purposes only. Any distribution, sharing or use, without the expressed consent of the Director of Research at EverFi, is strictly forbidden.
Haven Surveys 2014-2015