Survey - Sexual Behavior
Name: 


  1. Please mark how you feel about each of the following statements.

            1 2 3 4 5      
      I have a good idea of what my future holds for me. Strongly agree  Strongly disagree  
      I feel that I can resist the pressure to engage in sexual contact. Strongly agree  Strongly disagree  


  1. Please answer the following questions about resisting the pressure to engage in sexual contact.

    I have resisted the pressure to engage in sexual contact within the

            1 2      
      past month. Yes No  
      past 3 months. Yes No  
      past year. Yes No  


  1. Are you sexually active?
    Yes
    No


  1. If you are sexually active, how often do you use condoms?
     
      1 2 3 4 5  
    Always  Never


  1. If you do engage in sexual contact, please answer the following questions about condom use.

            1 2      
      I use a condom every time I engage in sexual contact. Yes No  
      I have used a condom in the past week. Yes No  
      I have used a condom in the past month. Yes No  
      I have used a condom in the past 3 months. Yes No  


  1. How do you feel that you can show love to someone?
    buy them flowers
    buy them gifts
    spend time with them
    write them letters, poems, songs, etc.
    have sex with them
    other ways...


  1. If you checked "other" in the above question, please dexcribe the ways you show love.


  1. I am enrolled in service activities.
    Yes
    No


  1. If you are enrolled in service activities, what type of activities do you participate in?