Sexual victimization and sexual assualt

Has anyone attempted and succeeded in having unwanted sexual contact by using physical force against you?

Yes ___

No ___

Has the unwanted sexual contact been carried out by a family member, or someone you were dating or an acquaintance?

Family member ___

Dating ___

Acquaintance

Has there been unwanted sexual contact by using physical force against you on/or off campus?

On campus ___

Off campus ___

Has the unwanted sexual contact by physical force been reported by you to the police?

Yes ___

No ___

Has the sexual criminal sexually harassed, or stalked you on campus or/off campus?

Yes ___

No ___

Has the sexual contact by physical force caused harassment by college peers or by faculty staff?

College peers Yes ___ No ___

Faculty Yes ___ No ___

Has the sexual contact by physical force caused you to experience some form of depression?

Yes ___

No ___

Has the sexual contact by physical forced caused you to drop college?

Yes ___

No ___

Has the sexual criminal been seen on campus or/ off campus?

Yes ___

No ___

Has your college institution responded in a prompt and professional manner concerning the sexual rape?

Yes ___

No ___