Create a Student ID
To maintain anonymity and track individual student progress, please create a student ID.
Enter the numerical day you were born. *
If you were born of the 1st of January, you would put “1”.
Enter the first two letters of the month you were born. *
If you born in August, you would put “AU”.
Enter the number of letters in your first name. *
If your name was Johnny, you would put “6”.
Please enter demographic data based on how YOU identify yourself.
What school do you attend? * What grade are you in? * 6th 7th 8th 9th 10th 11th 12th Other What is your gender? * Female Male Other I prefer not to answer What is your race? * African American/Black Asian Hispanic or Latino/a Middle Eastern/North African Multiracial Native America White/Caucasian Other I prefer not to answer Relationship Behaviors
Instructions: The next 10 questions (same as the pretest) ask you to think about various things that might happen in a relationship, and to rate them on a scale from healthy to abusive. We are asking you for YOUR OPINIONS about relationships IN GENERAL, not about your ACTUAL experiences.
Please read each statement carefully before answering.
If you have a disagreement, your partner uses the silent treatment and won’t talk to you for days. * Your partner threatens to share private pictures/text or details about your relationship with others. * Your partner tells you how special you are and how much they care about you. * You had a really good day and can’t wait to tell your partner because you know they will be excited to hear about it. * Your partner gets angry if you don’t respond ASAP to texts/messages. * You and your partner tell each other almost everything, but you feel like you can keep some things private if you want to. * Your partner uses physical force during an argument to stop you from leaving. * You don’t trust your partner unless you have access to their cell phone, social media, and location. * Your partner gets jealous if you are hanging out with certain people. * When you and your partner argue, you still feel safe to voice your opinion. * Dating Violence Prevalence
Instructions: The next questions are about dating relationships. By dating, we mean a relationship with a person who you are "talking to," "dating," "going out with" or “hooking up with”.
have had that kind of relationship with. This includes anyone who is or was your boyfriend or girlfriend, where you liked someone and they liked you back.
Are you currently dating someone? * Have you dated someone in the past year? *
If you did not answer “yes” to either of the above two questions, SKIP to the next section, "Evaluation Questions" at the end of the survey.
If you answered yes to either question above and you're dating or have dated someone in the past year, how often has...
NEVER means this has never happened in your relationship
RARELY means this has happened only 1-2 times in your relationship
SOMETIMES means this has happened about 3-5 times in your relationship
OFTEN means this has happened 6 times or more in your relationship
They sometimes want to control what you do. You sometimes try to control what they do. You did something to make them feel jealous. They did something to make you feel jealous. They insulted you with put-downs. You insulted them with put-downs. You touched them sexually when they didn’t want you to. They touched you sexually when you didn’t want them to. They harassed or stalked you through social media. You harassed or stalked them through social media. The following statements describe how safe your relationship felt. Please indicate how often you... ...felt afraid of being seriously hurt by them? ...think that they felt afraid of being seriously hurt by you? The following questions ask about the times you have been physically hurt in your relationship. “Hurt” means you could still feel pain in your body the next day. You are also hurt when you have a bruise, a cut that bleeds, or a broken bone. Please indicate how often... ...you have been physically hurt by them? ....you yourself physically hurt them? Evaluation Questions
You’re almost finished!
Instructions: Read the categories and circle the number for your answer.
Do you know a friend or peer who has been physically, emotionally, or sexually harmed by a dating partner? *
(If “yes,” go to next question. If “no,” SKIP the next question and proceed at the one after).
(SKIP if you did not answer “yes” to the previous question) Have you told a trusted adult about your friend or peer’s experiences? Have you ever personally witnessed dating and/or domestic violence in your family/household? * Did this program increase your knowledge about the issue of dating violence? * Did you learn any useful information or tools to keep your relationships and yourself healthy? * Are there any relationship issues or topics that were not covered that affects you and your friends? If yes, please describe.