2007 Youth Dating Survey

This survey was compiled by the Northwest Kansas Domestic and Sexual Violence Services, Inc. It was designed to gather data about high school juniors in the Northwest Kansas area to help the organization find out concerns and develop programs.


A red asterisk (*) indicates required questions.

  1. Your age:  *


  1. Your gender:  *


  1. Are you currently in a dating relationship?*
    Yes
    No


  1. Have you ever been in a dating relationship?*
    Yes
    No


  1. Does your past or current partner ever call you names, put you down or make negative comments about you in front of others?
    Yes
    No


  1. Has your partner ever caused you physical (bodily) harm, i.e. hit, kicked, punched, bitten, choked, slapped, etc?
    Yes
    No


  1. Has your partner ever threatened to cause you bodily harm?
    Yes
    No


  1. Has your partner ever hurt or threatened to hurt a friend or family member of yours if you didn't do something they wanted you to do?
    Yes
    No


  1. Have you had to start avoiding some or all of your friends due to your partner's jealousy?
    Yes
    No


  1. Has your partner ever driven recklessly while you were a passenger in their vehicle as a way to intimidate you?
    Yes
    No


  1. Has/does your partner follow you around school or around town in order to "keep on eye on you"?
    Yes
    No


  1. Has/does your partner threaten to commit suicide if you leave them?
    Yes
    No


  1. Has your partner ever forced or coerced you into having sex, or into performing sexual acts that you didn't want to do?
    Yes
    No


  1. Have you ever had "the feeling" that you were being abused by your partner, but you just aren't sure if it is/was abuse?
    Yes
    No


  1. Do you understand what "dating violence" is?
    Yes
    No


  1. Do you know someone in your peer group who is currently a victim of abuse (physical, verbal and/or emotional) from their boyfriend/girlfriend?
    Yes
    No


  1. Do you know someone who was previously in an abusive relationship who had to leave it due to the abuse?
    Yes
    No


  1. Have you ever tried to get help to get out of an abusive relationship?
    Yes
    No


  1. Have you ever assisted one of your friends or peers in getting out of an abusive relationship?
    Yes
    No


  1. Where would you most likely go for help? Please rank the following listings with "1" being the person you would approach first and end at "10" for the person you would least likely ask for help.

            1 2 3 4 5 6 7 8 9      
      teacher 1 10  
      parent 1 10  
      doctor/school nurse 1 10  
      clergy/church leader 1 10  
      coach 1 10  
      family member (sibling, grandparent, etc.) 1 10  
      school counselor 1 10  
      police officer 1 10  
      parent of a friend 1 10  
      domestic violence center/hotline 1 10  


  1. Approximately how many dating relationships have you been in?





Miss Peck
MMHS FACS Teacher
Mt Markham High School
West Winfield, NY