FACSAFoundation.org Shattering The Silence Tour Documentary Project February 2015 Volume 3 | Page 98

13) I was at what age when I was sexually assaulted. Circle All That Apply. 0-2 3-5 6-10 11-15 15-18 18-25 25-35 35-50 50-75 75-100 Does Not Apply 14) I have been sexually assaulted more than once. Circle One Strongly Agree Doesn’t Disagree Strongly Agree Disagree Apply 15) Were you sexually assaulted by? Circle All That Apply Father Mother Sibling Neighbor Step-Father Uncle Stranger Cousin Does Not Apply 16) I told Circle one or all that apply Father Mother Relative Police Teacher Clergy Friend Anyone No one 17) I was believed by the person I told? Circle One Strongly Agree Agree Disagree Strongly Disagree Doesn’t Apply