COMMUNITY ASSESSMENT ON STALKING Victim/Survivor Survey 1.  What is your gender?   Male    Female  2.  How old are/were you when the stalking began?   Less than 18 years    18 - 29 years    30 - 39 years    More than 40 years  3.  What state do you live in? AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWashington, DCWest VirginiaWisconsinWyoming 4.  Do/did you know who your stalker is/was?   Yes    No  5.  What is the stalker's gender?   Male    Female  6.  Do/did you have a prior relationship with your stalker?   Yes    No  7.  How long have you been/were you stalked?   Less than one year    1 - 3 years    3 - 6 years    6 - 9 years    More than ten years  8.  Does/did the stalker harass you via the Internet?   Yes    No  9.  Do/did you fear that you would be physically hurt?   Yes    No  10.  Did you notify your local police department?   Yes    No  11.  Do/did you keep a stalking log?   Yes    No  12.  Do/did you have a safety plan? (e.g. a safe place, self-defense lessons)   Yes    No  All questions were adapted from a survey developed by the Network for Surviving Stalking (NSS).

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