By completing this survey, you will be providing critical information that will help assess the needs of zerohour, this powerful and cutting edge campaign against discrimination and hate crimes brought to you by Rock the Vote and the Los Angeles County Commission on Human Relations. All change starts with YOU. Please take a few minutes to complete this survey. All responses will be completely confidential. |
| 1. |
What is your age? |
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| 2. |
Gender |
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Male
Female |
| 3. |
What grade are you
in? |
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| 4. |
Which of the following
best describes your race or ethnicity? |
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| 5. |
What is your zip
code? |
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| 6. |
What city were you
born in? (If out of state or country, please specify) |
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| 8. |
Number in household,
including yourself. |
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| 9. |
Parents' city of
birth. |
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| 10. |
How serious of a
problem do you think discrimination is among people your age? |
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Very serious
Somewhat serious
Not very serious
Not serious at all
Don't know |
| 11. |
How many times in
the last year have you been treated unfairly, made fun
of or harassed because of your: |
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| A. |
Race, ethnicity
or color? |
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| B. |
Religion? |
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| C. |
Gender? |
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| D. |
Sexual
Orientation/Preference? |
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| E. |
Disability? |
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| F. |
Friends/Peer
Group? |
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| G. |
Appearance
(e.g. hair color, weight, height)? |
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| 12. |
For each of the following
statements, please indicate if you strongly agree, agree, strongly disagree
or disagree: |
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| A. |
I have friends
of different races, religions, gender, etc. |
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| B. |
I am tolerant
of people who may seem different from me. |
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| C. |
Sometimes,
I make fun of other people because they are not like me. |
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| D. |
I know someone
who has been a victim of a hate crime. |
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| E. |
I do not think
there is anything wrong with using racial, ethnic or religious slurs. |
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| F. |
On occasion,
I use racial and ethnic slurs when talking to my friends about people
of different races, religions or ethnicities. |
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| G. |
When people
tell jokes about people of different religions, races, etc., I usually
laugh. |
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| H. |
It is normal
to make fun of kids in school who are "different"/not
"cool". |
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| I. |
In the past,
I have pre-judged someone, but realized I made a mistake after getting
to know him/her. |
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| 13. |
Had you ever heard
of an organization called Rock the Vote before today? |
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Yes
No |
| 14. |
Are you registered
to vote? |
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Yes
No |
| 15. |
Do you plan on registering
to vote when you're 18? (If you're not already registered) |
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Yes
No
Don't know/haven't decided
Already registered
Register
to Vote Here |
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