1. Ophelia's Place Outreach Survey II is a survey designed to help gather information about ways in
which Ophelia's Place can increase accessibility for all girls in our community.
High School Age
1. What is your age?
2. What is your ethnic identity? (Please mark all that apply.)
American Indian or Alaskan Native
Asian or Pacific Islander
Black or African American
Latina
White
Bi-racial or Multi-Racial
Other (please specify)
3. Please write all languages spoken in your home.
4. Please write your postal zip code.
5. What is your sexual identity? (Please mark all that apply.)
Female
Male
Gender Queer
Transgender
Intersex
Other

2. 6. What is your sexual orientation? (Please mark all that apply.)
Heterosexual
Bisexual
Queer
Lesbian
Gay
Pansexual
Asexual
Other
7. Have you heard of Ophelia's Place before?
Yes
No
Ophelia's Place offers girls empowerment services to any girl between the ages of 10-18. Some of these services include: after school
drop-in, therapy, school presentations, girl's empowerment groups, skill building classes and summer camps. Popular skill building
programs may include: cooking class, anime club, art classes and girl's rock jam sessions.
8. How relevant are Ophelia's Place services to you?
Very relevant
Somewhat revelant
Not relevant
Unsure
For the purpose of this survey, "girls or women of color" are defined as individuals who identify as Non-White.

3. 9. If you identify as a girl of color, what services do you feel would be helpful for you?
All female sex education
A safe place to talk about family, friend, and intimate relationships
Girls empowerment services offered in Spanish
Girl's group designed for young women of color
Counseling services
Other (please specify)
10. If you identify as a girl of color, what is the likelihood of you coming to Ophelia's Place?
Very likely
Somewhat likely
Not likely
Unsure
11. In your opinion, what is most convenient way to receive information about organizations like Ophelia's
Place?
Facebook
Twitter
Text messages
Word of mouth
School presentations
School counselor
Tabling events
Radio advertisements
12. If a Spanish speaking family or individual counselor was available at Ophelia's Place would you seek
out counseling services in Spanish?
Yes
No
Unsure

4. 13. How important is it for you to be able to get support from a woman who shares your ethnic identity?
Very important
Somewhat important
Not important
Doesn't matter
14. Are you aware of Young Amazing Woman of Color (YAWOC) groups offered by Ophelia's Place?
Yes
No
15. Are you a participant in any student minority unions (For example; Black Student Union, Asian/Pacific
Islander Student Union, Latino Student Union)?
Yes
No
16. If yes, would the Union that you are involved in be interested in information about Ophelia's Place
services?
Yes
No
Unsure
Other (please specify)
17. Are there any reasons that you wouldn't access services at Ophelia's Place?
Transportation (not having a way to get there)
Not enough information about Ophelia's Place
Not knowing anyone
Parent/Guardian permission
Please write any other activities that you would like to see offered at Ophelia's Place.