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
Dont 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 Immune Disability Syndrome
– Acute Intercourse Disease System
– Acquired Immune Deficiency Syndrome
8. What does HIV stand for?
– High Immune Virus
– Human Immunodeficiency Virus
