Email:

Phone Number:

School-Based Prevention Evaluation

Students: Consent and Communication

Consent and Communication

Date:

School-Based Survey Taken:

School Name:

Check the box for each action to show if your partner might be giving or not giving consent.

You see your partner is:

Looking away:

Giving consent

Not giving consent

Matching your level of excitement:

Giving consent

Not giving consent

Laughing uncomfortably:

Giving consent

Not giving consent

Asking for more:

Giving consent

Not giving consent

Crying:

Giving consent

Not giving consent

Whose job is it to make sure there's consent? (select all that apply):

Your job
Their job
Both of your jobs
Person with more power (when you and your partner have unequal power)

How would you respond to someone who didn't give you consent? (select all that apply):

Ask them again
Stop
Get angry
Suggest you do something else
Ignore them
Thank them for telling you

I know more about what consent is and what communication looks like in healthy relationships.:

Strongly Disagree

Disagree

Agree

Strongly Agree

I know more about the ways I can ask for and give consent.:

Strongly Disagree

Disagree

Agree

Strongly Agree

I know more about how consent is an ongoing part of relationships.:

Strongly Disagree

Disagree

Agree

Strongly Agree

I know more about the different ways people recognize and respond to a 'no' or lack of a 'yes.':

Strongly Disagree

Disagree

Agree

Strongly Agree

Name one way that consent can help create healthy relationships.:

Name two ways people communicate consent.:

Name one way that consent is an ongoing process in relationships of all kinds.:

Name one way to respond if someone shows or communicates 'no' or lack of a 'yes'.: