SAMPLE COMMUNITY SURVEY

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We, Parents for Better Education in Anytown, are a group of parents and community members concerned with the sexuality education that young people in this community receive. We are conducting this survey to determine what parents in this community would like their children to learn and at what age level. We hope to share this information with the school board so that they can understand what this community wants and determine whether the existing program is sufficient. Thank you for taking the time to help us! 1. Do you believe the school should provide sexuality education to students... in high school?                                            Yes / No in middle school/junior high school?         Yes / No in elementary school?                                 Yes / No 2. If sexuality education was offered at your child's school would you allow your child to participate? Yes / No 3. Which of the following topics would you want your high school age child to learn about in a school-based sexuality education class? (Check all that apply)* _____ STDs other than HIV/AIDS _____ HIV/AIDS _____ How to talk with parents about sex _____ Basics of how babies are made _____ Waiting to have intercourse until older _____ Birth Control _____ How to deal with emotional issues and consequences of being sexually active _____ Waiting to have intercourse until married _____ How to talk with a girlfriend/ boyfriend about "how far to go" sexually _____ How to make responsible sexual decisions based on individual values _____ Where to get contraceptives _____ Abortion _____ How to put on a condom/use contraception _____ Masturbation _____ Homosexuality and sexual orientation _____ That teens can obtain birth control pills from family planning clinics and doctors without permission from a parent _____ Oral Sex 4. Which of the following topics would you want your middle school/ junior high school age child to learn about in a school-based sexuality education class? (Check all that apply)* _____ STDs other than HIV/AIDS _____ HIV/AIDS _____ How to talk with parents about sex _____ Basics of how babies are made _____ Waiting to have intercourse until older _____ Birth Control _____ How to deal with emotional issues and consequences of being sexually active _____ Waiting to have intercourse until married _____ How to talk with a girlfriend/ boyfriend about "how far to go" sexually _____ How to make responsible sexual decisions based on individual values _____ How to use and where to get contraceptives _____ Abortion _____ How to put on a condom _____ Masturbation _____ Homosexuality and sexual orientation _____ That teens can obtain birth control pills from family planning clinics and doctors without permission from a parent _____ Oral Sex 5. Which topics listed above, if any, do you feel strongly that the school district should not cover in a sexuality education class? Please explain. _______________________________________________________________ _______________________________________________________________ _______________________________________________________________ _______________________________________________________________ 6. Which do you think best describes the approach you would like sexuality education to take? _____ teach young people to remain abstinent until they marry _____ stress the benefits of abstinence but also teach young people about the benefits of contraception and disease prevention if they do become sexually active _____ teach a wide-range of subjects including abstinence, pregnancy and disease prevention, relationships, communication skills, and negotiation skills. _____ Other. Please explain: _______________________________________________________________ _______________________________________________________________ _______________________________________________________________ _______________________________________________________________ * Topics taken from Sex Education in America; General Public/Parents Survey (Washington, DC: National Public Radio/ Kasier Family Foundation/ Kennedy School of Government, January 2004).

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