Sample of a Questionnaire

Topics: AIDS, HIV, Sexual intercourse Pages: 5 (658 words) Published: January 5, 2009
Name - Sahil Malhotra

Subject – Written Communication(COM 210)

Topic – Sample Questionnaire

Assignment no – 4

Date of submission – 1st October 2008

Attitude, Awareness Level towards Sex Education in India

This survey questionnaire is being undertaken to find the Attitude & Awareness Level towards Sex Education for Men and Women in the age group of 18-24.


1. Use a tick mark or a circle to select the appropriate answer. 2. Certain questions have multiple answers. The word ‘Multiple’ next to the question signifies the same. 3. The answers of the questions will be kept discreet from others and your privacy will be best maintained. 4. Please answer the questions with utmost honesty.

Your Profile

Age - Sex - Occupation - Marital Status -

Your Background

1. When was Sex Education first imparted to you?

9th/10th Standard 11th/12th Standard

Junior/Senior College Never

2. How do/did you clarify your doubts on Sex Education? (Multiple)

Friends Siblings Parents

Internet Teachers or Professors in school/college

Professional Campaigns/Workshops
3. How often do you or make your partner use protection for sex?

Always Frequently Rarely Never

4. Which form of protection is most likely used by you or by your partner? (Multiple)

Birth control pills Condoms Female Contraceptives

Don’t use any

5. What compels you to have safe sex? (Multiple)

Unwanted Pregnancy Fear of STDFear of HIV/AIDS

Request/Authority of the opposite partner Do not practice safe sex

6. How many sexual partners have you had?

None1-34-67-9 10 & above

Your Awareness

7. Expand the abbreviation AIDS.

- Additional Illness during sex
- Affected Immune Disability Syndrome
- Acute Intercourse Disease System
- Acquired Immune Deficiency Syndrome

8. What does HIV stand for?

- High Immune Virus
- Human Immunodeficiency Virus
- Human Intersexual Virus
- Human Immune Virus

9. How does the HIV Virus spread? (Multiple)

- Unsafe Sex
- Sharing household items such as utensils, towels
- From an infected mother to her unborn child
- Kissing or French Kiss
- Sharing facilities such as swimming pool, sauna, toilets - Sharing needles with an infected person

10. Is HIV synonym (another word) for AIDS?


11. Can a person become HIV+ or acquire AIDS without any sexual activity?

YES NO Don’t know

12. Commonly, how soon can the HIV virus be detected?

6-12 weeks 13-20 weeks 21-27 weeks 28 weeks and above

13. What is the full form of STD?

- Sex with Deficient Immunity
- Sex Transferred Deficiency
- Sexually Transmitted Disease
- Socially Transferred Sexual Disease

14. What do you understand by the term monogamy/polygamy?

- Different form of Sexual Diseases
- Single and Multiple sexual partners at any particular time - Sexual organs of men and women
- Terms given to rapists, molesters and other sexual offenders

Your Attitude

15. What is the most suitable age to impart Sex Education?


16. What do you think is the best medium to impart sexual education to today’s youth? (Multiple)

Open discussions Print/Books Visual Let them decide

17. Are you comfortable in clarifying Sexual issues/doubts to your friends and/or siblings of the same sex?

- Comfortable in dealing with friends and siblings
- Comfortable in dealing with friends only
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