Gender at school survey template
NOTE: THIS TEMPLATE IS NOT BUILT FOR OR INTENDED FOR DISTRIBUTION TO MINORS UNDER 16 (OR A HIGHER AGE DEPENDING ON YOUR LOCATION). Visit the
Acceptable Uses Policy
for more information.
1.
Do you believe there is gender equality among the students at your school?
Yes
No
2.
How would you describe the gender representation among the faculty and staff at your school?
Men are over-represented
Women are over-represented
Men and women are equally represented
3.
Do you think your school should make a public statement regarding the Supreme Court’s decision to overturn Roe vs. Wade?
Yes, supporting the decision
Yes, opposing the decision
No
My school has already released a statement
4.
How much do you agree or disagree with the following statement: Supporting access to reproductive care, including abortion, demonstrates a school’s commitment to supporting and advancing women.
Strongly agree
Somewhat agree
Somewhat disagree
Strongly disagree
5.
Given the Supreme Court decision, are you considering doing any of the following?
Switching to a school that
offers more
reproductive healthcare benefits, information, or aligns with my personal beliefs
Switching to a school that
doesn’t offer
reproductive healthcare benefits, information, or aligns with my personal beliefs
I am not considering switching schools
6.
Does your school allow its students to openly protest or express their beliefs related to social issues?
Yes
No
7.
Which race or ethnicity best describes you? (Select all that apply)
American Indian or Alaska Native
Asian or Asian-American
Black or African-American
Hispanic or Latino/a
Middle Eastern or North African
Native Hawaiian or Pacific Islander
White
Another race (please specify)
8.
What is your age?
9.
Which of the following best describes your affiliation with the school?
Staff / Faculty
Student
Other (please specify)
10.
What is your gender identity?
Man
Woman
Non-binary
Prefer to self-describe (please specify)