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  1. Surveys
  2. 2017
  3. April
  4. D
  5. Domestic Violence Anonymous Survey
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Questions marked with a * are required Exit Survey
 
 
* How old are you?
 
13-20
 
20-30
 
30-40
 
40-50
 
50-60
 
65+
 
 
 
* What is your race/ ethnicity?
 
Black or African America
 
Hispanic
 
White
 
Asian
 
Native American
 
Pacific Islander
 
Other
 
 
 
 
* Have you ever been directly involved in domestic violence?
 
Yes
 
No
 
 
 
* Was the abuse reported?
 
Yes
 
No
 
Other
 
 
 
 
If not can you please list a reason why:
   
 
 
 
Did anyone else know about the abuse?
 
Yes
 
No
 
 
 
If your answer was yes, who?
   
 
 
 
Are you aware that there are different forms of abuse?
 
Yes
 
No
 
 
 
* If you were not personally abused, do you know someone who was abused?
 
Yes
 
No
 
 
 
Do you know if they reported the abuse?
 
Yes
 
No