Sample Format From Women’s Questionnaire

	Number of times since age 14 (circle one)
Type of Sex First Format:
Since the age of 14, has a man ever fondled, kissed, or sexually touched you without your consent…
by overwhelming you with continual arguments and pressure although you indicated you didn’t want to?	0	1	2	3 or more
by telling lies or making promises that he knew were untrue (after you indicated you didn’t want to)?	0	1	2	3 or more
by showing displeasure by making you feel guilty, swearing, sulking, or getting angry (after you indicated you didn’t want to)?	0	1	2	3 or more
by giving you alcohol without your knowledge or consent?	0	1	2	3 or more
by giving you drugs without your knowledge or consent?	0	1	2	3 or more
when you were passed out or too intoxicated to give consent or stop what was happening?	0	1	2	3 or more
by using some degree of physical force (twisting your arm, holding you down) or in any other way restraining or physically hurting you?	0	1	2	3 or more
Type of Tactic First Format:
Since the age of 14, has a man ever overwhelmed you with continual arguments and pressure, although you indicated you didn’t want to, in order to…	Number of times since age 14 (circle one)
fondle, kiss, or sexually touch you without your consent?	0	1	2	3 or more
attempt to make you have sexual intercourse with him, but for some reason intercourse did not happen?	0	1	2	3 or more
make you have oral sex with him?	0	1	2	3 or more
make you have sexual intercourse with him?	0	1	2	3 or more
make you have anal sex or insert an object into you?	0	1	2	3 or more