Control Group Survey

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(This survey is for individuals who have NOT experienced sexual assault or rape)

First name

Last name

Phone

Phone country code (If outside of U.S.)

Address

Zip code/postal code

City

State

Country

Date of birthdate (mm-dd-yyyy)

Country of origin

Nationality

Race / Ethnicity

Gender

Sexual preference

Are you willing to participate in a noninvasive research study that includes traditional talk therapy?

Do you have any siblings?

How many Girls?

How many Boys?

Who should we contact in the event of an emergency? Name

Emergency contact’s number

What is your current educational level

Note: You are a part of the control group for rape research at the Jeanine Horowitz Research Center (JHRC). Which means your answers will be compared to rape survivors. You should only complete this part of survey IF you have never experienced sexual assault or rape? Remember:
Did you remember to email your Patient Identification Number to yourself:

Share your feelings
Please share how you feel by choosing one statement that closely matches how you’ve been feeling in the past week. Don’t take too long over your replies, as your immediate answers are most accurate.
How Do you feel right Now?

I feel tense or wound up

I still enjoy the things I used to enjoy:

I get a sort of frightened feeling as if something awful is about to happen:

I can laugh and see the funny side of things

Worrying thoughts go through my mind:

I feel cheerful:

I can sit at ease and feel relaxed:

I feel as if I am slowed down:

I get a sort of frightened feeling like 'butterflies' in the stomach:

I have lost interest in my appearance:

I feel restless as I have to be on the move:

I look forward with enjoyment to things:

I get sudden feelings of panic:

I can enjoy a good book or radio or TV program:

Have you ever reported a non sexual related crime to the police?

What was the crime you reported to law enforcement?

Did the police investigate the crime and follow up with you after the police report was taken?

When you reported the non sexual crime was an official police report made, and were you provided the officer car or contact information for follow up?

Did a detective from the police department meet with you to investigate the matter after you filed the police report?

In what time frame did you report the incident?

In what city and state and/or country did the non-sexual related crime occur?

In what city and state and country did you report the non-sexual related crime?

Was the local police department quick to respond?

How long did it take for the police to arrive to take police report?

Did you drive to the station or was a police report taken over the phone?

Did the police department conduct a thorough investigation?

Was the accused taken in for questioning regarding your police report?

Was the accused arrested for the crime committed against you?

Was the suspect arrested, charged, and convicted?

Criminal/Victim of Crime Resources
Did the convicted criminal serve anytime for the non-sexual related crime that was committed against you?

Were you notified when the suspect was released from jail or prison?

Were you notified when about the criminal prosecution process related to the non-sexual crime you reported and resulted in prosecution?

When your case was over and/or the suspect was released was there a protective order established and again, were you notified of the outcome of court proceedings?

Outside of investigation and/or prosecuting were you offered any restitution from your local government or law enforcement agency?

On a scale of 1 to 10 (1 being the lowest and 10 being the greatest) how would you rate your overall experience with making a police report for a non-sexual related crime and the response of the local government’s agency?

On a scale of 1 to 10 (1 being the lowest and 10 being the greatest) how would you rate your overall experience with receiving restitution for a non-sexual related crime and the response of the local government’s advocate?

How many months did it take for you receive any recovery or restitution from law enforcement agencies?

What services were you provided from filing a non-sexual criminal report (if any)?

Do you know a person that has experienced rape?

Do you know the first name of the person that committed the alleged rape or sexual assault?

What is the last name of the person that committed the alleged rape or sexual assault?

What did you say when to the person when they shared their trauma from rape or sexual assault?

Did they tell you in a private place?

Did you tell anyone else?

Did you encourage the sexual assault or rape survivor to report the incident to the police?

Did you notice any behavior changes in your friend that was sexually assaulted or rape?

Do you know the difference between sexual assault and rape?

Explain in your own words what does it mean to be sexually assaulted?

Explain in your own words what does it mean to be rape?

Have you ever had a close encounter that you feared rape or sexual assault?

What are some precautions you specially implement to protect yourself from experiencing an sexual assault and/or rape?

Did you know that the FBI states that only 2 percent of women falsely report sexual assault and rape to the police?