Items:

1.Someone fondled, kissed, or rubbed up against the private areas of my body (lips, breastchest, crotch or butt) or removed some of my clothes without my consent (but did not attempt sexual penetration) by:

a. Telling lies, threatening to end the relationship, threatening to spread rumors about them, making promises about the future I knew were untrue, or continually verbally pressuring them after they said they didn’t want to.
b. Showing displeasure, criticizing their sexuality or attractiveness, getting angry but not using physical force after they said they didn’t want to.
c. Taking advantage when they were too drunk or out of it to stop what was happening.
d. Threatening to physically harm them or someone close to them.
e. Using force, for example holding them down with my body weight, pinning their arms, or having a weapon.

2.Someone had oral sex with me or made me have oral sex with them without my consent by:

a. Telling lies, threatening to end the relationship, threatening to spread rumors about them, making promises about the future I knew were untrue, or continually verbally pressuring them after they said they didn’t want to.
b. Showing displeasure, criticizing their sexuality or attractiveness, getting angry but not using physical force after they said they didn’t want to.
c. Taking advantage when they were too drunk or out of it to stop what was happening.
d. Threatening to physically harm them or someone close to them.
e. Using force, for example holding them down with my body weight, pinning their arms, or having a weapon.

3.If you are a male, check box and skip to item 4
A man put his penis into my vagina, or someone inserted fingers or objects without my consent by:

a. Telling lies, threatening to end the relationship, threatening to spread rumors about them, making promises about the future I knew were untrue, or continually verbally pressuring them after they said they didn’t want to.
b. Showing displeasure, criticizing their sexuality or attractiveness, getting angry but not using physical force after they said they didn’t want to.
c. Taking advantage when they were too drunk or out of it to stop what was happening.
d. Threatening to physically harm them or someone close to them.
e. Using force, for example holding them down with my body weight, pinning their arms, or having a weapon.

4.A man put his penis into my butt, or someone inserted fingers or objects without my consent by:

a.Telling lies, threatening to end the relationship, threatening to spread rumors about them, making promises about the future I knew were untrue, or continually verbally pressuring them after they said they didn’t want to.
b.Showing displeasure, criticizing their sexuality or attractiveness, getting angry but not using physical force after they said they didn’t want to.
c.Taking advantage when they were too drunk or out of it to stop what was happening.
d.Threatening to physically harm them or someone close to them.
e.Using force, for example holding them down with my body weight, pinning their arms, or having a weapon.

5.Even though it didn’t happen, someone TRIED to have oral sex with me, or make me have oral sex with them without my consent by:

a.Telling lies, threatening to end the relationship, threatening to spread rumors about them, making promises about the future I knew were untrue, or continually verbally pressuring them after they said they didn’t want to.
b.Showing displeasure, criticizing their sexuality or attractiveness, getting angry but not using physical force after they said they didn’t want to.
c.Taking advantage when they were too drunk or out of it to stop what was happening.
d.Threatening to physically harm them or someone close to them.
e.Using force, for example holding them down with my body weight, pinning their arms, or having a weapon.

6.If you are male, check this box and skip to item 7.
Even though it didn’t happen, a man TRIED to put his penis into my vagina, or someone tried to stick in fingers or objects without my consent by:

a.Telling lies, threatening to end the relationship, threatening to spread rumors about them, making promises about the future I knew were untrue, or continually verbally pressuring them after they said they didn’t want to.
b.Showing displeasure, criticizing their sexuality or attractiveness, getting angry but not using physical force after they said they didn’t want to.
c.Taking advantage when they were too drunk or out of it to stop what was happening.
d.Threatening to physically harm them or someone close to them.
e.Using force, for example holding them down with my body weight, pinning their arms, or having a weapon.

7.Even though it didn’t happen, a man TRIED to put his penis into my butt, or someone tried to stick in objects or fingers without my consent by:

a.Telling lies, threatening to end the relationship, threatening to spread rumors about them, making promises about the future I knew were untrue, or continually verbally pressuring them after they said they didn’t want to.
b.Showing displeasure, criticizing their sexuality or attractiveness, getting angry but not using physical force after they said they didn’t want to.
c.Taking advantage when they were too drunk or out of it to stop what was happening.
d.Threatening to physically harm them or someone close to them.
e.Using force, for example holding them down with my body weight, pinning their arms, or having a weapon.

Response Options:

i.How many times in the past 12 months?
0, 1, 2, 3+

ii.How many times since age 14?
0, 1, 2, 3+

8.I am:
Female
Male

My age is _____ years and __months.

9.Did any of the experiences described in this survey happen to you 1 or more times?

Response Options:
Yes
No

What was the sex of the person or persons who did them to you?

Response Options:
Female only
Male only
Both females and males
I reported no experiences

10.Have you ever been raped?

Response Options:
Yes
No