Sex Education Survey (For Students)

2. Default Section
1. Does your school offer sex education?
If so, what is the name of the sex education curriculum that you use at your school and who teaches the program?
Yes
No
I'm not sure

Name of your school, sex education curriculum, and teacher:

2. Does your program provide students with information about using birth control and contraceptives?
Yes
No
I'm Not Sure
Do you have a specific comment about your program and how it addresses birth control or contraceptives?

3. Does your program teach students how to use condoms and contraceptives as a means of reducing the risk of HIV/STIs* and pregnancy?

*Sexually-Transmitted Infections
Yes
No
I'm Not Sure
Just As a Means to Reduce Pregnancy
Just As a Means to Reduce the Risk of HIV/STIs
Do you have a specific comment about your program and how it addresses these issues?
4. Does your program mention Gardasil, the HPV vaccine? Is the vaccine recommended?
Yes, Gardasil is mentioned and recommended
Yes, Gardasil is mentioned, but NOT recommended
No, Gardasil is not mentioned
I'm not sure

Do you have a specific comment about your program and how it addresses Gardasil, the HPV Vaccine?
5. Does your program teach students that abstinence (avoiding all sexual activities) until marriage is the only means of reducing the risk of HIV/STIs and
pregnancy?
Yes, I learned that abstinence until marriage is the only way to reduce the risk of pregnancy AND HIV/STIs.
Yes, I learned that abstinence until marriage is the only way to reduce the risk of pregnancy, but NOT HIV/STIs.
Yes, I learned that abstinence until marriage is the only way to reduce the risk of HIV/STIs, but NOT pregnancy.
No, I learned that abstinence is the only way to reduce the risk of pregnancy and HIV/STIs, but we never talked about "abstinence until marriage".
No, I never learned any of that.
I'm not sure.

Do you have a specific comment about your program and how it addresses abstinence?
6. Does your program address issues of gender and sexual identity?
Yes, we address those issues.
No, we do not address those issues.
 I'm not sure.
I'm not sure what that means.

Do you have a specific comment about your program and how it addresses gender or sexual identity?
7. What is the overall goal of the program?
and
What message does the program provide students about sex?

8. Is the program offered as an elective or a required course for students?

Elective
Required Course
I'm Not Sure
9. Does your school require parent’s permission for students to take the course?
Yes
No
I'm Not Sure
10. What grade are you in currently?
and
As a student, do you feel that the information you are receiving is appropriate for your age?
Yes, I think the program is age-appropriate
No, I don't think the program is age-appropriate
I'm Not Sure

5. Which of the following topics were covered in your sexual education program or class?
 STIs/ STDs
Condoms
Birth Control
Consent
Abstinence
Accurate Male Anatomy
Accurate Female Anatomy (including Clitoris)
Gender Spectrum
Sexuality
Pregnancy/ Birth
Purity Rings
I have never received formal sexual education
Other (please specify)

*6. How old were you when you first received formal sexual education?
I have never received formal sexual education
Age:

*7. In what context(s) did you receive formal sexual education?

Church or other religious group
Religion-based school
 Public school
Private school (non-religious)
Parents/ Guardians
Seminar
Planned Parenthood
LGBTQAI+ Center
I have never received formal sexual education

Other (please specify)

*8. Read the following statements and select how closely you feel they apply to your formal sexual education experience (1- I don't feel
that this applies to me at all, 5- I feel this applies to me almost exactly)
Somewhat applies to Applies to me almost
Does not apply to me 2 me 4 exactly N/A

I felt prepared I felt prepared I felt prepared

I felt prepared for I felt prepared I felt prepared I felt prepared
for sexual activity for sexual activity for sexual activity
sexual activity after for sexual activity for sexual activity for sexual activity
after my after my after my
my program/class. after my after my after my
program/class. Does program/class. Some program/class. Applie
program/class. 2 program/class. 4 program/class. N/A
not apply to me what applies to me s to me almost exactly

I feel like I am I feel like I am I feel like I am

I feel like I am well I feel like I am I feel like I am I feel like I am
well educated on all well educated on all well educated on all
educated on all birth well educated on all well educated on all well educated on all
birth control birth control birth control
control options. birth control birth control birth control
options. Does not options. Somewhat options. Applies to
options. 2 options. 4 options. N/A
apply to me applies to me me almost exactly
 Somewhat applies to Applies to me almost
Does not apply to me 2 me 4 exactly N/A

I would feel I would feel

I would feel ashamed I would feel
I would feel ashamed to engage is I would feel ashamed to engage is I would feel
to engage is sexual ashamed to engage is
ashamed to engage is sexual ashamed to engage is sexual ashamed to engage is
activity sexual activity Does
sexual activity 2 activity Somewhat sexual activity 4 activity Applies to me sexual activity N/A
not apply to me
applies to me almost exactly

I feel my program I feel my I feel my I feel my

I feel my I feel my I feel my
encouraged program encouraged program encouraged program encouraged
program encouraged program encouraged program encouraged
acceptance of non- acceptance of non- acceptance of non- acceptance of non-
acceptance of non- acceptance of non- acceptance of non-
heterosexual, and heterosexual, and heterosexual, and heterosexual, and
heterosexual, and heterosexual, and heterosexual, and
non-cisgendered non-cisgendered non-cisgendered non-cisgendered
non-cisgendered non-cisgendered non-cisgendered
persons persons Does not persons Somewhat persons Applies to me
persons 2 persons 4 persons N/A
apply to me applies to me almost exactly

I feel the amount of I feel the amount I feel the amount I feel the amount
I feel the amount I feel the amount I feel the amount
information given of information given of information given of information given
of information given of information given of information given
was appropriate for was appropriate for was appropriate for was appropriate for
was appropriate for was appropriate for was appropriate for
my age my age Does not my age Somewhat my age Applies to me
my age 2 my age 4 my age N/A
apply to me applies to me almost exactly

I want to wait (or I want to wait (or I want to wait (or

I want to wait (or I want to wait (or I want to wait (or I want to wait (or
have waited) until have waited) until have waited) until
have waited) until have waited) until have waited) until have waited) until
marriage to have marriage to have marriage to have
marriage to have sex marriage to have marriage to have marriage to have
sex Does not apply to sex Somewhat applies sex Applies to me
sex 2 sex 4 sex N/A
me to me almost exactly

I would/do feel less I would/do feel I would/do feel I would/do feel

I would/do feel I would/do feel I would/do feel
worthy after having less worthy after less worthy after less worthy after
less worthy after less worthy after less worthy after
sex having sex Does not having sex Somewhat having sex Applies to
having sex 2 having sex 4 having sex N/A
apply to me applies to me me almost exactly

I feel more I feel more I feel more I feel more

I feel more I feel more I feel more
comfortable/knowled comfortable/knowled comfortable/knowled comfortable/knowled
comfortable/knowled comfortable/knowled comfortable/knowled
geable about my body geable about my body geable about my body geable about my body geable about my body geable about my body geable about my body
after my after my after my
 Somewhat applies to Applies to me almost
Does not apply to me 2 me 4 exactly N/A
after my program/class Does after my program/class Somew after my program/class Applies after my
program/class not apply to me program/class 2 hat applies to me program/class 4 to me almost exactly program/class N/A

I feel more I feel more I feel more I feel more

I feel more I feel more I feel more
comfortable/ comfortable/ comfortable/ comfortable/
comfortable/ comfortable/ comfortable/
knowledgeable about knowledgeable about knowledgeable about knowledgeable about
knowledgeable about knowledgeable about knowledgeable about
my gender/sexuality my gender/sexuality my gender/sexuality my gender/sexuality
my gender/sexuality my gender/sexuality my gender/sexuality
after my after my after my after my
after my after my after my
program/class program/class Does program/class Somew program/class Applies
program/class 2 program/class 4 program/class N/A
not apply to me hat applies to me to me almost exactly

I would have I would have I would have

I would have liked for I would have
liked for my I would have liked for my I would have liked for my
my program/class to liked for my
program/class to have liked for my program/class to have liked for my program/class to have
have covered more program/class to have
covered more program/class to have covered more program/class to have covered more
topics covered more
topics Does not apply covered more topics 2 topics Somewhat covered more topics 4 topics Applies to me
topics N/A
to me applies to me almost exactly

I feel my class/ I feel my class/ I feel my class/ I feel my class/

I feel my class/ I feel my class/ I feel my class/
program interfered program interfered program interfered program interfered
program interfered program interfered program interfered
with my religious with my religious with my religious with my religious
with my religious with my religious with my religious
beliefs beliefs Does not apply beliefs Somewhat beliefs Applies to me
beliefs 2 beliefs 4 beliefs N/A
to me applies to me almost exactly

I feel that sexual I feel that sexual I feel that sexual

I feel that sexual I feel that sexual
education encourages I feel that sexual education encourages I feel that sexual education encourages
education encourages education encourages
young children to education encourages young children to education encourages young children to
young children to young children to
have sex too young children to have sex too young children to have sex too
have sex too early have sex too
early Does not apply have sex too early 2 early Somewhat have sex too early 4 early Applies to me
early N/A
to me applies to me almost exactly

I feel that I know how I feel that I know I feel that I know I feel that I know
I feel that I know I feel that I know I feel that I know
to prevent sexually how to prevent how to prevent how to prevent
how to prevent how to prevent how to prevent
transmitted diseases sexually transmitted sexually transmitted sexually transmitted sexually transmitted
sexually transmitted sexually transmitted
diseases 2 diseases 4 diseases N/A
 Somewhat applies to Applies to me almost
Does not apply to me 2 me 4 exactly N/A
diseases Does not diseases Somewhat diseases Applies to
apply to me applies to me me almost exactly

I feel that I
I feel that I I feel that I
I feel that I would I feel that I would know what to I feel that I I feel that I
would know what to would know what to
know what to do if would know what to do if my primary would know what to would know what to
do if my primary do if my primary
my primary method do if my primary method of birth do if my primary do if my primary
method of birth method of birth
of birth control failed method of birth control method of birth method of birth
control failed Does control failed Applies
control failed 2 failed Somewhat control failed 4 control failed N/A
not apply to me to me almost exactly
applies to me
I feel pressured to
engage in sexual
activity