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2013
January
D
Domestic Violence
Domestic Violence
0%
Exit Survey
What is your age?
18-24
25-30
31-35
36+
Other
Marital Status?
Married
Single
Divorced
Seperated
Other
If Married, How long?
Less than One year
1 year+
5 years+
10 years +
How many children do you have?
0-1
2-5
5+
No Children
How old were you when you first became a vicitm domestic violence?
0-18
18-24
25-35
36+
After leaving the relationship, which services were most helpful to you?
Hotlines
Shelters
Long term counseling
short term counseling
Other
What do you consider to be your ethnicity?
What is your Occupation?
Religious Preference
Protestant
Catholic
Jewish
Muslim
Hindu
None
Other(please explain)
what is the highest grade/level of school completed?
8th grade or less
Some high school, but did not graduate
High school diploma or GED
Some college or Associate degree
4-year college
4+year college
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