HighSchoolClimateSurvey:Isyourschoolclimate

including&opentoeveryone?
Todayyouarebeingaskedtocompleteabriefsurveyinordertogatherchallengesandconcerns
regardingLGBTQAstudentsinyourschool.Asyourespondtoeachitem,focusonyourthoughts
andfeelingsbasedonyourownpersonalexperiencesasastudentatyourschool.Thissurveyis
confidentialandyourindividualresponseswillnotbesharedwithyourteacherorclassmates.Allyour
responsesarecompletelyanonymous.Weaskthatyoubehonestinyouranswers.Theresultswill
beusedtobettersupportyouandbettermeettheneedsofLGBTQA...studentpopulations.The
surveyshouldtakeyouapproximately1015minutestocomplete.

Thankyoufortakingthetimetoanswerthissurvey!
PleaseSelectOnlyOneAnswerforeachQuestion

1. 1.Age
Markonlyoneoval.
14
15
16
17
18
2. 2.Belowisalistoftermsthatpeopleoftenusetodescribetheirsexualityorsexual
orientation.Pleaseselecttheonethatyoumostidentifywith.
Markonlyoneoval.
Gay
Lesbian
Bisexual
Pansexual
Asexual
Queer
Straight/Heterosexual
Questioning
Other:

3. 3.Belowisalistoftermsthatpeopleoftenusetodescribetheirgender.Pleaseselectthe
onethatyoumostidentifywith.
Markonlyoneoval.
Male
Female
Transgender
TransgenderMaletoFemale
TransgenderFemaletoMale
TwoSpirit
Genderqueer
Genderless
Genderfluid
Other:
4. 4.Whatisyourraceorethnicity?Pleaseselecttheonethatyoumostidentifywith.
Markonlyoneoval.
Asian
PacificIslander
NativeAmerican
AlaskanNative
BlackorAfricanAmerican
WhiteorEuropeanAmerican
HispanicorLatina/Latino
Multiracial
Other:
5. 5.Howoftendoyouhearthefollowingremarksinahomophobicmanner(suchas"That's
sogay","You'resogay",faggot,dyke,"queer",etc.):
Markonlyoneovalperrow.
Never

Rarely

Sometimes

Often

Always

inSchool
fromStudents
fromStaff
6. 6.Howoftendoyouhearhomophobicremarksin:
Markonlyoneovalperrow.
Never
classes
hallways
bathrooms
lockerRooms
buses
athleticevents/gymnasium
cafeteria
school

Rarely

Sometimes

Often

Always

7. 7.Howoftenarenegativeremarksrelatedtoapersonssexualorientationmadeby:
Markonlyoneovalperrow.
Never

Rarely

Sometimes

Often

Always

students
teachersorstaff
8. 8.Whenyouhearnegativeremarksrelatedtoapersonssexualorientation,howoften
doesa/do:
Markonlyoneovalperrow.
Never

Rarely

Sometimes

Often

Always

studentintervene
teacherorstaffintervene
youintervene
9. 9.Howoftenhaveyouheardcommentsaboutstudentsnotacting:
Markonlyoneovalperrow.
Never

Rarely

Sometimes

Often

Always

"masculine"enough
"feminine"enough
10. 10.Howoftenarenegativeremarksrelatedtoapersonsgenderexpressionmadeby:
Markonlyoneovalperrow.
Never

Rarely

Sometimes

Often

Always

students
teachersorstaff
11. 11.Whenyouhearnegativeremarksrelatedtoapersonsgenderexpression,howoften
doesa/do:
Markonlyoneovalperrow.
Never

Rarely

Sometimes

Often

Always

studentintervene
teacherorstaffpersonintervene
youintervene
12. 12.IfyouidentifyasanLGBTQAidentifiedperson,howoftendoyoufeelunsafein:
Markonlyoneovalperrow.
Never
classes
hallways
bathrooms
lockerrooms
buses
athleticEvents/gymnasium
cafeteria
school

Rarely

Sometimes

Often

Always

13. 13.Ifyouidentifyasanally,howoftendoyouthinkanLGBTQAidentifiedpersonfeels
unsafein:
Markonlyoneovalperrow.
Never

Rarely

Sometimes

Often

Always

classes
hallways
bathrooms
lockerrooms
buses
athleticevents/gymnasium
cafeteria
school
14. 14.HowlikelyisanLGBTQAidentifiedpersontoexperience__________inyourschool?
Markonlyoneovalperrow.
Never

Rarely

Sometimes

Often

Always

lackofconcern
exclusion
verbalharassment
physicalharassment
physicalassault
15. 15.Howlikelyisapersontoexperienceharassmentatyourschoolduetotheir:
Markonlyoneovalperrow.
Never

Rarely

Sometimes

genderexpression
sexualorientation
physicalappearance
16. WhatLGBTQresources/supportareyou
lookingforthemostinyourschooland/or
community?

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Often

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