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LGBT Life Center
Empowering the LGBTQ and HIV communities since 1989.
Call Us
(757) 640-0929
Email Us
info@lgbtlifecenter.org
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RISE Post-Meetup Survey
RISE Post-Meetup Survey
Please enable JavaScript in your browser to complete this form.
Name
*
First
Last
Today's date
*
Please complete each of the statements below. Circle ONE number that best reflects how you feel right now.
I feel alone in the world
Never
Sometimes
No opinion
Most of the time
Always
I wish I could have more respect for myself
Never
Sometimes
No opinion
Most of the time
Always
I am comfortable with my sexual orientation/identity
Never
Sometimes
No opinion
Most of the time
Always
My health is very important to me
Never
Sometimes
No opinion
Most of the time
Always
I am likely to seek social support from my peers
Never
Sometimes
No opinion
Most of the time
Always
I feel good about myself
Never
Sometimes
No opinion
Most of the time
Always
I am likely to access health services (HIV testing/care, medical, dental, drug treatment)
Never
Sometimes
No opinion
Most of the time
Always
I am likely to access other services (educational, support group, housing, employment)
Never
Sometimes
No opinion
Most of the time
Always
I feel good about my attraction to men
Never
Sometimes
No opinion
Most of the time
Always
I feel like I am a part of a group or community
Never
Sometimes
No opinion
Most of the time
Always
If I could change my sexual orientation, I would
Never
Sometimes
No opinion
Most of the time
Always
I feel comfortable sharing my feelings with others
Never
Sometimes
No opinion
Most of the time
Always
I understand how homophobia affects the way I feel about myself
Strongly disagree
Disagree
No opinion
Agree
Strongly agree
I understand how oppression affects my decisions about my health
Strongly disagree
Disagree
No opinion
Agree
Strongly agree
I intend to use protection to prevent transmission of HIV
Strongly disagree
Disagree
No opinion
Agree
Strongly agree
I intend to seek other health services and/or screenings in the next 4 weeks
Strongly disagree
Disagree
No opinion
Agree
Strongly agree
Overall Retreat || Circle ONE number that best reflects how you feel right now.
Overall, how satisfied are you with the retreat?
Very
Somewhat
Not at all
After having participated in the RISE retreat program do you have a greater understanding of homophobia and oppression?
Yes
No
After having participated in the RISE retreat program do you have a greater intention to seek health related services or screenings in the future?
Yes
No
Questions? Thoughts? Comments?
Let us know how we can improve or what you loved!
Comment
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