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Sample of a Questionnaire
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.

Instructions

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 STD Fear of HIV/AIDS

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

6. How many sexual partners have you had?

None 1-3 4-6 7-9 10 & above

Your Awareness

7. Expand the abbreviation AIDS.

- Additional Illness during sex - Affected
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