STUDENT REGISTRATION Before Anyone Else: The Daisy Coleman Consent Culture Peer Educator Certification Program (BAE Training)
This form serves as both registration and a climate survey.
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Email *
Last Name *
First Name *
Cell # *
State *
How did you hear about the training? (or from whom?) *
What is your age? *
What is your race/ethnicity? *
What is your gender identity? *
How do you define your sexual or affectional orientation? *
Required
What is the full name of your high school? *
SCHOOL CLIMATE:  To what extent do you agree or disagree with the following statements: *
Strongly agree
Agree
Neutral
Disagree
Strongly disagree
I think my school does a good job of teaching consent & healthy relationships.
I think my school does a good job of teaching bystander intervention.
I think my school does a good job of making sure I know my Tile IX rights.
I think my school does a good job of teaching where and who to report a sexual harassment or assault to in school.
The dress code is applied fairly at my school.
Students at my school have been assaulted and school staff, didn’t help them.
Students at my school have been assaulted and their peers didn’t believe them.
Sexual violence and harassment is a serious problem at my school.
KNOWLEDGE: To what extent do you agree or disagree with the following statements: *
strongly agree
somewhat agree
neutral
somewhat disagree
strongly disagree
I understand all of the elements that contribute to rape culture.
I know the differences between sexual harassment, sexual assault, and rape.
I am able to explain all elements of consent to a peer.
I know what an unhealthy relationship looks like.
I know steps to safely leave an unhealthy relationship.
I feel that I can identify negative actions, relationship models, or how sex is portrayed in media.
I know the risks of sending nude images.
If I had a peer disclose to me that they had been sexually assaulted, I would know exactly how to respond.
I know how to report sexual violence or harassment that happened to a peer or me.
I know my rights in school under the federal law Title IX.
I am aware of all the options available for healing from sexual trauma, in case I or a friend might need them.
I know all ways to be an active bystander.
ATTITUDES: To what extent do you agree or disagree with the following statements: *
Strongly agree
Somewhat Agree
Neutral
Somewhat Disagree
Strongly disagree
I have not given much thought to the topic of sexual consent.
Before making sexual advances, I assume ‘‘no’’ until there is clear indication to proceed.
If both people are drunk, consent isn't a factor.
ACTIONS: How often do you find yourself in the following situations: *
Very often
Somewhat often
Neutral
Not very often
Not at all
I intervened when someone made a joke that's sexually harassing or suggestive.
Discussed consent with a sexual partner
Explained to someone that their actions or beliefs are sexually demeaning
Stopped a partner who was pressuring you sexually
Stopped a peer who is trying to take advantage of another person who is intoxicated
Pointed out something in media that was contributing to rape culture
Found resources for healing from sexual violence for yourself or a friend.
Supported a partner or peer who experienced sexual violence
A copy of your responses will be emailed to the address you provided.
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