SURVEY for Pre-registration
Survey For Sex Re-Education Class
Is this something you would be interested in?
Yes No Maybe
Have you ever contracted an STD?
Yes No I don’t know
Are you sexually active?
Yes No
If yes, how long has it been since you have been tested?
_______________________________________
Are any of these lessons interesting to you? If so, put a check by them.
Yes No
Lesson Plans That Are Available
o Anatomy
o Safe Sex
o Sexually Transmitted Infections
o HIV/AIDS
o LGBTQI Community
o Rape/Consent/Domestic Violence
o Safe Sexual Positions and Props
o Sexual/Physical/Financial Abuse
o Sex in a Nursing Home
o Masturbation/Toys/Alternative Sexual Practices
o Field Trip to Sex Ship
o Relationships
o Sexual Issues for Older Adults
o Chronic Illness Affecting Sexual Happiness
What would a class like this be worth to you?
$50 $100 $200 $400 ___________
Is there anything else that you would be interested in learning about?
Yes No
If you circled yes, tell me what else?
Health? Stress Management? Fitness?
Meditation? Yoga?
Something else?
Is this something you would be interested in?
Yes No Maybe
Have you ever contracted an STD?
Yes No I don’t know
Are you sexually active?
Yes No
If yes, how long has it been since you have been tested?
_______________________________________
Are any of these lessons interesting to you? If so, put a check by them.
Yes No
Lesson Plans That Are Available
o Anatomy
o Safe Sex
o Sexually Transmitted Infections
o HIV/AIDS
o LGBTQI Community
o Rape/Consent/Domestic Violence
o Safe Sexual Positions and Props
o Sexual/Physical/Financial Abuse
o Sex in a Nursing Home
o Masturbation/Toys/Alternative Sexual Practices
o Field Trip to Sex Ship
o Relationships
o Sexual Issues for Older Adults
o Chronic Illness Affecting Sexual Happiness
What would a class like this be worth to you?
$50 $100 $200 $400 ___________
Is there anything else that you would be interested in learning about?
Yes No
If you circled yes, tell me what else?
Health? Stress Management? Fitness?
Meditation? Yoga?
Something else?