The following anonymous survey will ask you a series of questions about your sexual experience. Please answer as honestly and completely as you can. There are no right or wrong answers. Your responses will help us to continue to develop programs and materials which meet the needs of the Body of Christ. The survey will ask a number of very serious and sensitive questions. Some of them may cause you to feel embarrassed. Some of your responses may cause you to feel shame or guilt. Please do not participate in the survey if doing so threatens your sobriety in any way. Your participation is voluntary and you may stop at any time.
*All fields marked with a are required:**
Your age as of your last birthday: *
Gender: *	Male Female
Which statement best describes the family you grew up in? *
Your Current Marital Status:*
Where did you first learn about sex? *
At approximately what age did you first learn about sex? *
How often in the last 12 months have you seen sexually explicit material in the form of magazines, videos or DVDs (sexually explicit means that the material shows people either partially or fully nude and which is clearly designed to draw a sexual response from the viewer – as opposed to a medical textbook which educates a person on human anatomy – OR which shows one or more persons engaged in any type of sexual behavior)? *
How old were you the first time you were exposed to sexually explicit materials?*
What type of material were you first exposed to? (e.g., Playboy or other “soft porn” magazines, “hard core” pornography, videos, DVDs, etc…) *
How often in the last 12 months have you seen sexually explicit material on the internet? *
How old were you the first time you saw sexually explicit materials on the internet?*
Have you ever masturbated? *	Yes No
If yes, approximately how old were you? *
How did you discover masturbation? *
How often do you masturbate? *
Have you ever paid for sexually oriented materials or services on the internet? *	Yes No
If yes, how much would you estimate you have spent in the last 6 months? *
Have you ever paid for sexual services with a person? (e.g., prostitute or massage parlor) *	Yes No
If yes, how much would you estimate you have spent in the last 6 months? *
Have you ever paid for phone sex? *	Yes No
If yes, how much would you estimate you have spent in the last 6 months? *
How old were you the first time you experienced fondling, or petting, with another person? *
How old was your partner at that time? *
How old were you when you first had oral sex ?*
How old was your partner at that time? *
How old were you the first time you had intercourse? *
How old was your partner at that time ?*
The first time you had intercourse did either you or your partner use alcohol or drugs prior to having intercourse? *	Yes No Not Applicable
Which of the following motivated you to have intercourse the first time? *
Curiosity:*	Yes No
Peer Pressure:*	Yes No
Physical Desire:*	Yes No
Fear or Intimidation:*	Yes No
Love:*	Yes No
How many people have you had intercourse with in the last 12 months? *
How many people have you had intercourse with in your life? *
How many times have you had intercourse in the last 12 months? *
Approximately how many years older than you was your oldest intercourse partner ? *
Approximately how many years younger than you was your youngest intercourse partner ? *
Within the last two months, have you engaged in any of the following with a person of the opposite sex?*
Kissing:*	Yes No
Petting:*	Yes No
Fondling:*	Yes No
Oral Sex:*	Yes No
Intercourse:*	Yes No
Within the last two months, have you engaged in any of the following with a person of the same sex?*
Kissing:*	Yes No
Petting:*	Yes No
Fondling:*	Yes No
Oral Sex:*	Yes No
Intercourse:*	Yes No
Have you ever struggled with homosexual feelings ?*	Yes No
Do you believe yourself to be a homosexual? *	Yes No Not Sure
Which of the following people know about your sexual behaviors? *
Spouse:*	Yes No
Parent:*	Yes No
Sibling:*	Yes No
Friend:*	Yes No
Teacher:*	Yes No
Counselor:*	Yes No
Pastor:*	Yes No
How many people have you given oral sex to in the past 12 months ?*
How many times have you given oral sex in the past 12 months ?*
How many times have you received oral sex in the past 12 months ?*
When you engage in sexual behaviors, how often are drugs and/or alcohol involved? *
Have you ever been sexually abused or molested ? *	Yes No
If yes, by whom? *
Have you ever been raped? (Raped means that someone forced you to have sexual intercourse with him or her against your will) *	Yes No
If yes, by whom? *
Do you consider yourself to be a Christian? *	Yes No Not Sure
Do you think that the Church's attitudes about sex are too negative or rigid? *	Yes No Not Sure
Would you like to get more teaching about sex at Church ? *	Yes No Not Sure
Is there anything in your experience that we did not ask about? If yes, please list it here:
Please make any comments you think would be helpful to us:

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