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Ex-Gay Survivors Survey

This survey is specifically for ex-gay survivors to give voice to some of their experiences in ex-gay ministries and similar organizations. It takes just a few minutes and you can stay as anonymous as you like. If you can't find answers that fit your experience, there are plenty of empty boxes for you to express yourself as accurately as possible.

Thank you for your time...

Jallen, Christine, and Peterson at beyondexgay.com

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* 1. What kind of ex-gay activities did you participate in? (check as many as applicable)

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* 2. In general, how long a period of time was your experience?

  Years Months
Amount of time

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* 3. During your ex-gay experience, what was your religious affiliation?

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* 4. Approximately, how much money did you spend on the experience?

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* 5. What were the reasons (the motivations) you tried to follow an ex-gay path? (you may select as many reasons as you like.)

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* 6. What were you hoping to get from (the results you wanted from) your ex-gay experience? (check as many as applicable)

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* 7. What signifigant experience motivated you to quit the ex-gay movement? (check as many as applicable)

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* 8. Do you feel that you were harmed by your ex-gay experience?

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* 9. If you feel that you were harmed, please check the below boxes that describe the kinds of harm you experienced: (check as many as applicable)

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* 10. To what degree does the harm of your ex-gay experience still affect you today?

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* 11. What good, if any, came out of your ex-gay experience?

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* 12. What have you done or experienced that has helped you to recover and undo the ex-harm?

For statistical purposes, please check the boxes/titles you are comfortable using to describe yourself today.

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* 13. What gender identification do you use?

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* 14. What is your sexual orientation?

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* 15. What is your religious/spiritual affiliation?

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* 16. What is your Ethnicity?

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* 17. What Country, State/Province do you live in?

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Optional

This part of the survey is optional. We are building a list of people who are available for interviews and telling their stories. If you are interested in being part of that contact list, please fill out your contact information. BE AWARE: This list is confidential. Your contact information will NEVER be given out without first getting your permission. For example, if a media outlet in your area needed an ex-gay survivor, we would FIRST contact you to see if you would be up for the task, then you would contact the media outlet.

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* 18. Your contact information:

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* 19. At what approximate age did you begin to actively pursue an ex-gay experience?

T