PARENT/COMMUNITY SEX EDUCATION SURVEY (Sample)
PARENT/COMMUNITY SEX EDUCATION SURVEY (Sample)
The __________________ School District is in the process of reviewing the sex education/reproductive health education program to better meet the needs of students as well as the standards of the community. Thank you for taking a few minutes to complete the following survey and share your thoughts with us.
1. Should the school district include a set of lessons on sex education/reproductive health at the:
(Please circle one response for each level.)
| Elementary Level | Middle School Level | High School Level |
| Yes | No | Yes | No | Yes | No |
2. If a set of lessons were offered at the age-appropriate grade level, would you allow your child(ren) to participate?
(Please circle one response.)
| Yes | No | I don’t have children currently enrolled in the school district |
3. At what grade should each of the following possible sex education/reproductive health topics first be taught?
(Please check one box for each of the following topics.)
|Topics |Elementary |Middle |High School |Do Not Think Topic |
| | | | |Should Be Taught in |
| | | | |School |
|K |1 |2 |3 |4 |5 |6 |7 |8 |9 |10 |11 |12 | | |A. Puberty and Adolescence: Teaches boys and girls about the physical, emotional, and social changes of puberty and adolescence | | | | | | | | | | | | | | | |B. Reproductive Anatomy: Describes male and female reproductive anatomy and function. | | | | | | | | | | | | | | | |C. Positive Communication With Family: Encourages students to talk with their parents and other trusted adults about feelings, relationships, and setting limits. | | | | | | | | | | | | | | | |D. Positive Friendships: Identifies characteristics of positive friends including initiating, maintaining, and ending friendships. | | | | | | | | | | | | | | | |E. Child Sexual Abuse: Teaches personal safety concepts, such as good touch-bad touch, stranger danger and identifying trusted adults who can help. | | | | | | | | | | | | | | | |F. Healthy Dating Relationships: Recognizes healthy and unhealthy relationships. Differentiates between emotional and physical intimacy, and limit setting. | | | | | | | | | | | | | | | |G. Abstinence: Discusses benefits of abstaining from sex or ceasing sexual activity. Teaches assertiveness skills for resisting pressure, such as communication and refusal. | | | | | | | | | | | | | | | |H. Skills to Avoid Risky Behaviors: Includes developmental skills, such as decision-making, communication, assertiveness, refusal, and negotiation, to avoid risky situations. | | | | | | | | | | | | | | | |I. Legal Consequences of Underage Sex: Provides information about the criminal consequences of underage sexual activity. | | | | | | | | | | | | | | | |J. Pregnancy and Childbirth: Explains how pregnancy occurs, the importance of prenatal care and how babies are born. | | | | | | | | | | | | | | | |K. Parenting Responsibilities: Explores the responsibilities of parenting (e.g., economic, physical, emotional, social, and legal) and their impact on future goals. Provides information on responsibilities to children born in and out of wedlock. | | | | | | | | | | | | | | | |L. Adoption and Safe Delivery: Provides information an adoption services and the safe delivery of newborns law. | | | | | | | | | | | | | | | |M. Sexually Transmitted Diseases (including HIV/AIDS): Includes information about the transmission, symptoms, treatment, and prevention of sexually transmitted infections, such as chlamydia, gonorrhea, genital herpes, genital warts, and HIV/AIDS. | | | | | | | | | | | | | | | |N. Risk Reduction: Provides information about condoms as a means to reduce risk for HIV and other sexually transmitted infections. | | | | | | | | | | | | | | | |O. Contraception: Provides information about birth control methods, such as condoms, birth control pills, and Depo-Provera and their role in preventing pregnancy. | | | | | | | | | | | | | | | |P. Sexual Orientation/Identity: Teaches that all students deserve to be treated with respect (i.e., no name-calling, taunting, bullying) and that some students self-identify or are perceived to be gay, lesbian, or bisexual. | | | | | | | | | | | | | | | |Q. Harassment, Sexual Assault and Rape: Provides information about the law, prevention skills, and where to go for help. | | | | | | | | | | | | | | | |R. Other: | | | | | | | | | | | | | | | |
4. Please share any additional comments or thoughts.
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Thank you for completing this survey. The results will help the district be responsive to parent views.
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