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18
questionnaire
Feminine
Please supply accurate information. All questions should be answered with reference to the time of occurrence.
1. Incident Month
Please select an option
January
February
March
April
May
June
July
August
September
October
November
December
2. Incident Year
Please select an option
2025
2024
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
1951
1950
1949
1948
1947
1946
1945
1944
1943
1942
1941
1940
1939
1938
1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
3. Country
Please select an option
Nigeria
4. Gender
Please select an option
Female
5. Marital Status
Please select an option
Single
Married
Divorced
Widowed
Separated
6. Age Category
Please select an option
Below 16
16-17
18-21
22-24
25-28
29-31
32-35
36-40
41-45
46-50
51-55
Above 55
7. Education
Please select an option
Primary School Certificate
O Level / A Level Certificate
College Diploma
Polytechnic Diploma
University Degree
Post Graduate Degree
Other Diploma
No formal Education
8. Occupation
Please select an option
Student
Employed
Business Person
Apprentice
Trader
Freelancer
Artisan
Unemployed
Full time Housewife
Creative
9. Incident Category
Please select an option
Verbal abuse
Physical abuse
Sexual abuse
Physical & Verbal abuse
Physical & Sexual abuse
All
10. Perpetrator
Please select an option
Boyfriend/Partner
Fiance
Friend
Family
Acquaintance
Husband
Neighbor/housemate
Colleague/co-worker/co-student
Unknown
11. Action Taken
Please select an option
Filed an official report/complaint
Filed an unofficial report/complaint
Only told family/friend(s)
Did nothing
12. Help Received
Please select an option
Spiritual
Medical
Professional
None
13. State Of Incident
Please select an option
Abia
Adamawa
Akwa Ibom
Anambra
Bauchi
Benue
Borno
Bayelsa
Cross River
Delta
Ebonyi
Edo
Ekiti
Enugu
Federal Capital Territory
Gombe
Imo
Jigawa
Kaduna
Kebbi
Kano
Kogi
katsina
Kwara
Lagos
Nassarawa
Niger
Ogun
Ondo
Osun
Oyo
Plateau
Rivers
Sokoto
Taraba
Yobe
Zamfara
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