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What is your sex?
 
Female
 
Male
 
 
 
What is your Age?
 
18-21
 
22-25
 
26-29
 
30-39
 
40-55
 
56>
 
 
 
Are you a nursing student or RN?
 
Student
 
RN
 
 
 
What is your sexual orientation? (for statistical results only)
 
Gay (male)
 
Heterosexual
 
Lesbian
 
 
 
What semester nursing student are you?
 
1st.
 
2nd.
 
3rd.
 
4th
 
5th.
 
6th.
 
 
 
Did you fail out of nursing school?
 
Yes
 
No
 
 
 
Did you drop out of nursing school?
 
Yes
 
No
 
Other
 
 
 
 
Did you repeat any semester in nursing school and if so how many?
 
Yes
 
No
 
1.
 
2.
 
3.
 
 
 
How long have you been a RN?
 
1-3 years
 
4-6 years
 
7-10 years
 
11-15 years
 
16-20 years
 
20> years
 
 
 
What year did you graduate from nursing school?
 
 
Other
 
 
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