1. Do they threaten or intimidate to get you to comply?

2. Do they destroy or threaten to destroy your personal property and possessions?

3. Are they violent toward a pet or an object (a wall, furniture, etc.)?

4. Do they yell or scream?

5. Do they call you names?

6. Do you feel constantly harassed by them?

7. Do they embarrass you, make fun of you, or mock you, either alone, in public, or in front of
family or friends?

8. Do they criticize or minimize your goals and accomplishments?

9. Is it obvious they do not trust your decision-making?

10. Do they tell you that you are worthless without him or her?

11. Are they overly possessive to the point of isolating you from friends and family?

12. Do they often check up on you to make sure you are home or where you said you would be?

13. Do they say hurtful things while under the influence of drugs or alcohol, then blame the drugs or
alcohol for saying them?

14. Do they blame you for how he or she acts or feels?

15. Do they abandon you after a fight or make you stay after a fight in order to "teach you a
lesson"?

16. Do they make you feel there is no way out of the relationship?

SEXIST REMARKS
Indicators Frequently Often Sometimes Rarely Never
(5) (4) (3) (2) (1)
1. I hear the expression “That’s so gay,” or
“You’re so gay” from other students at school.
2. I hear other homophobic
remarks used at school (such as “faggot,”
“dyke,” “queer,” etc.)
3. I hear other homophobic remarks from
professors or school staff.
4. They call me names
5. They embarrass, make fun, or mock me
either alone, in public, or in front of family or
friends

Indicators Frequently Often Sometimes Rarely Never

(5) (4) (3) (2) (1)
1. I hear sexist remarks used at school (such as
someone being called a “bitch” or comments
about womens’ bodies or talk of women being
inferior to men)
2. I hear hear sexist remarks from professors or
school staff.
3. They tell
4.
5.