The questionnaire was developed initially by a team at the University of Michigan, which included contributions from the Survey Research Center, the Office of Student Life, the Office of the Vice President & General Counsel, and the Sexual Assault Prevention and Awareness Center (CAPAC).  Additionally, there was oversight from the University of Michigan Presidents Office.  SoundRocket also contributed to the questionnaire.

Other Features & Customizations

  • Unwanted experience section is designed to minimize burden on survivors. Only asks minimum questions necessary.
  • Questions and question logic takes into account respondent gender, including transgendered students.
  • Customize language used in the survey with local wording (by respondent, if desired).
  • Customize the response options included in all items shown in red in this document.

After a successful implementation at Michigan, the data were analyzed and the questionnaire was adjusted according to the initial results.  The University of Michigan Survey Research Center and SoundRocket collaborated on revisions to the instrument with the two primary 2016 Spring participating schools - New York University and the University of New Mexico - to ensure that the questionnaire translated well to a multi-institutional setting.

The questionnaire is now stabilized and will not be changing significantly over time.  The intent is to use this questionnaire to track changes over time for participating institutions - which means stability in the questionnaire is critical.  The NCCS will continue to allow institutions to tailor the questionnaire in some ways.

A complete version of the questionnaire that was most recently fielded can be made available for schools seriously considering participation.  If you would like to receive a copy, please contact us by email or phone.

The following summary of measures represents the topics covered by the current questionnaire.

Summary of Measures

Unwanted Experiences

  • Unwanted Experiences
    • Fondling
    • Oral Sex
    • Vaginal penetration
    • Anal penetration
  • Timeframe Captured
    • Past 12 months
    • Since enrollment
    • Lifetime
  • Other Details
    • Frequency of incidents
    • Number of perpetrators
  • Harassment without contact (past 12 months & number of perpetrators)
  • Where incident of unwanted experience in past 12 months reported, respondent is asked to consider the most recent, and asked:
    • Gender of perpetrator
    • Relationship of perpetrator
    • Perpetrator affiliation & role
    • Experience with reporting & reasons for non-report (if app)
    • Location of incident


  • Age, Gender, Race, Ethnicity, Disability
  • Generational Status, Citizenship Status
  • Marital / Relationship Status
  • Campus Related: First enrolled, program status, online course experience

Campus Experiences

  • Campus work / instructional roles
  • Living arrangement
  • Group membership
  • Alcohol in past 30 days

Campus Resources

  • Knowledge of & Where to find policy
  • Awareness of local efforts on topic
  • How school handles sexual misconduct
  • Awareness of specific services
  • Experience with general programs
  • Experience with specific programs
  • Know where to get help?
  • Likelihood to report
  • Where to report

Sexual Experiences

  • Past 12 months’ sexual experience (any)
  • Verbal / Non-verbal consent
  • Alcohol / Intoxication /
    Drugs during sexual experience

Other Measures

  • Domestic violence in past 12 months
  • Bystander behavior in past 12 months
  • Perpetration questions (OPTIONAL)