This is for my dissertation and no names or identification will be used.
My email
bonniegjennings@gmail.com
Anonymous Childhood Experience Survey
No names. No emails. No identifying details.
Please answer only with the letters/numbers listed. Your privacy comes first.
1. Age Range
1 — Under 18
2 — 18–24
3 — 25–34
4 — 35–44
5 — 45–54
6 — 55–64
7 — 65+
2. Gender
A — Female
B — Male
C — Non-binary
D — Prefer not to say
3. Location of the Abuse (Select all that apply)
H — Home
R — Relative’s home
S — School
C — Church / religious setting
F — Friend’s home
O — Outdoors
X — Other
4. Perpetrator (Select all that apply)
1 — Biological father
2 — Stepfather
3 — Mother’s partner/boyfriend
4 — Sibling
5 — Other relative
6 — Family friend
7 — Teacher or coach
8 — Minister / clergy
9 — Stranger
0 — Prefer not to say
5. Your Birth Order
A — Oldest
B — Middle
C — Youngest
D — Only child
E — Prefer not to say
6. Did You Ever Report It?
Y — Yes, as a child
A — Yes, as an adult
N — No
P — Prefer not to say
7. Optional Comment
You may share anything you feel comfortable adding, in your own words.
(Please do not include names, towns, or identifying details.)
My Near Death Experience Arts and Thoughts 