SURVEY... thank you for taking time

SURVEY
AGE: ______

Please send your results back to Lise.artlover@gmail.com Jst cut and paste, fill in and end. Very easy.

I am doing a compilation of women’s concerns, worries and issues regarding self defense, self protection and general welfare. We are reviewing our training to make sure it fits toward today’s needs and wants. In order to do so I am conducting a short survey. No names are necessary unless you wish to do so. Personal information will be kept confidential and will NOT be shared with anyone. Just mention your age since this variable is very relevant. Please take a few minutes to help me help you better. Feel free to pass this survey out to your friends and relative as we are trying to get the widest perspective possible. If you find some questions too difficult to answer, just skip and fill out the rest. I would rather have a partial survey and than none at all.
When you have completed the survey you can either email it or snail mail it.
Thank you very much for your time and help in this matter. I truly appreciate it.
Please take time to help other women.


1. Do you feel threatened in your daily life/ activities? ______________
2. Are you concerns with break ins?______________________________
3. Are you concerns with your work place? ________________________
4. What type of work, outside of the home, do you do? _________________
5. Are you concerned that certain friends you have may hurt you (physically or emotionally)?__________________________________________
6. Are you concerned that certain relatives you have may hurt you (physically or emotionally)?_______________________________________________
7. Do you frequently go to establishments where drinking is permitted (bars, clubs, etc) ? ___________________________________________________
8. Are you concerned about date rape? _____________________________
9. Have you ever been attacked or assaulted? _________________________
10. If yes to the last question, are you concerned it will happen again? ______
11. Have you ever been subjected to a violent crime? ____________________
12. If yes to the last question, were you injured in the process? ____________
13. Did you ever experience a criminal pretending to be a delivery person or repairman or such? ___________________________________________
14. If yes to the last question, did you fall prey to them? __________________
15. Have you been subjected to domestic violence or abuse? ____________
16. Do you know anyone who has been subjected to a violent crime? _______
17. If yes to the last question, did it affect your view on your personal safety and if so how? _____________________________________________
18. Where do you live: city suburb country
19. Are you concerned with traveling? ______________________________
20. Do you travel outside of the country? ____________________________
21. Have you ever been stalked? ___________________________________
22. If yes to the last question, how did it end? ________________________

On a scale of 1 to 10, how do you rate the followings concerns:
• Being “pawed” in a bar or at a party 1 2 3 4 5 6 7 8 9 10
• Someone jumping out of the dark to attack you 1 2 3 4 5 6 7 8 9 10
• Carjacking 1 2 3 4 5 6 7 8 9 10
• Having your purse stolen out of your hands 1 2 3 4 5 6 7 8 9 10
• Someone breaking in your house while you are sleeping
1 2 3 4 5 6 7 8 9 10
• If you have children, concerns about their safety 1 2 3 4 5 6 7 8 9 10
• Being raped 1 2 3 4 5 6 7 8 9 10
• Innapropriate sexual conduct toward you 1 2 3 4 5 6 7 8 9 10
• Being hurt during a violent crime 1 2 3 4 5 6 7 8 9 10
• Losing material possessions 1 2 3 4 5 6 7 8 9 10
• Being emotionally abused 1 2 3 4 5 6 7 8 9 10
• Being held at gun point 1 2 3 4 5 6 7 8 9 10
• Being held at knife point 1 2 3 4 5 6 7 8 9 10
• Being shot 1 2 3 4 5 6 7 8 9 10
• Someone beating you up badly 1 2 3 4 5 6 7 8 9 10
• Being attacked by another woman 1 2 3 4 5 6 7 8 9 10
• Being attacked by a group of people 1 2 3 4 5 6 7 8 9 10
• Being abducted 1 2 3 4 5 6 7 8 9 10
• Being stuck in a violent relationship 1 2 3 4 5 6 7 8 9 10
• Racial crime 1 2 3 4 5 6 7 8 9 10
• Being stalked 1 2 3 4 5 6 7 8 9 10


COMMENTS: (anything that would cover violence or criminal attack or behavior that you are concerned about of have experienced. Details will be kept confidential. Use more paper if necessary.)