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Who's Positive
 

Who's Positive Survey

Program Survey
1. I am
Please choose: female
male
transgender
2. My sexual orientation is:
Please choose: bisexual
gay
heterosexual
lesbian
3. My age is:
Please choose: 17/younger
18-20
21-23
24-29
30-39
40-49
50 or older
4. My status is:
Please choose: 1st/2nd semester
3rd/4th semester
5th/6th semester
7th/8th semester
graduate student
faculty
staff
community member
5. My ethnicity is:
Please choose: African American/Black
American Indian
Asian American/Pacific Islander
Caucasian American
Hispanic/Latino American
International
Multiethnic/Multiracial
6. What do you think the quality of the presentation was?
Please choose: Outstanding
Very Good
Good
Fair
Poor
7. Watching this program was...
Please choose: a requirement
for extra credit
neither a requirement or extra credit
8. I watched:
Please choose: Live webcast
an in person program
9. Please name the venue where you saw the program
10. I have decided as a result of seeing the program to get tested for HIV
Please choose: YES
Yes, I plan on being tested through the Rapid Testing offered at LHU Wed 9 to midnight or Thurs 9am - 3:15
No
Already been tested
11. Would you recommend this program to other institutions?
Please choose: Yes
No
Maybe
12. How would you rate the impact of the presentation?
Please choose: Outstanding
Very Good
Good
Fair
Poor
13. I would like more information on HIV/AIDS
Please choose: Yes
No thank you.
14. I would like to be added to the Who's Positive mailing list, my information is provided below
Please choose: Yes
No, thank you
15. I would like more information on how I can become more active in bringing awareness to HIV/AIDS to my school
Please choose: Yes
No, thank you
16. Please offer suggestions, ideas or impact statements.
17. *OPTIONAL* Please Provide your name and email address
 


 
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Disclaimer: This site contains HIV prevention messages that may not be appropriate for all audiences. This information should not be substituted for the advice of a doctor or other professional. Who's Positive staff and sponsors assume no liability or responsibility for personal, financial, medical, or legal decisions made by users of this site.