Name *

Position *

School or Organization *

Phone *

Email *

Does your school/organization currently deliver instruction on teen pregnancy or STD/HIV prevention?

Yes

No

OtherOther

Are you using a curriculum? If so, which one?

Puberty Happens

Best Practices in STD/HIV and Pregnancy Prevention

OtherOther

If some level of sexuality education is provided, what topics need more attention?

What challenges do you face in delivering sexuality education?

Time constraints

Lack of administrative support

Lack of staff available to deliver content

Staff is not comfortable delivering content

OtherOther

What do you see as important issues in your community related to youth sexual health?

What specific youth populations are you planning to serve? Check all that apply:

Does your school district currently have any policies around teaching sexuality education, mandated reporting, or protecting students’ sexual health rights? If yes, please describe:

Does your school district or organization currently use data collection to assess student needs and outcomes?

What areas do staff delivering sexuality education need more support in?

Does your school or organization offer any of the following services that support students’ ability to prevent teen pregnancy and STDs/HIV?

Guidance or counseling staff

School based health clinic

School nurse or other health care providers on staff

Diversity team or Gay-Straight Alliance (or equivalent)

OtherOther

What school & community programs are you interested in collaborating with to help promote sexual health, teen pregnancy prevention or positive youth development?

Become a Partner

Access to Care Is at Risk