Projet DAPHNE

UNITED KINGDOM

This survey, which is strictly confidential, is part of the Daphne programme of the European Union. Our organisation is part of this programme and has a project, partly financed by the European Union, which aims to defend, within the 15 European Countries, the interest of blind and partially sighted women and especially those who face or have faced any kind of violence, be it verbal, psychological, physical or social violence.

Please could you spend a few minutes of your time filling in this short questionnaire? Your answers will help us to improve our knowledge of the violence disabled women are facing, to raise awareness in our organisations and to develop actions to combat violence.

The questionnaire comprises questions with "yes" or "no" answers. You can complete it on paper, "on line" or by phone.

To complete it on paper, simply circle or underline your answer. Then post your completed questionnaire to the Royal National Institute for the Bllnd at 105 Judd Street, London WC1H 9NE.

To complete it "on-line", just click on your answers & when you have finished click "submit".

Or you can give your answers by phone - just ring Alison Partridge on 0208 941 2390. Alison will also be able to answer any queries you may have relating to the questionnaire, or the project as a whole.

This personal information is strictly confidential. A number and a code for the analysis of the results will replace your personal data.

Please indicate the easiest way to contact you (name, alias, telephone number) or, if you prefer, contact us at the following number: 0208 941 2390.

Name:
First name:
Alias:

Street, n°:
City:
Country:

E-mail:
Phone number:
contact hours:

Would you be interested in participating at a peer-group on women and violence in your city or close to your city? Yes, I would be interested No, I am not interested


Would you be interested in participating at a self-defence training course in your city or close to your city? Yes, I would be interested No, I am not interested

1. Have you ever faced or do you face psychological violence? 1.1.Yes, I do face psychological violence 1.2.Yes, I have ever faced psychological violence 1.3.No, I don't face psychological violence 1.4.No, I have never faced psychological violence 2. Have you ever faced or do you face physical violence? 2.1.Yes, I do face physical violence 2.2.Yes, I have ever faced physical violence 2.3.No, I don't face physical violence 2.4.No, I have never faced physical violence 3. Have you ever faced or do you face any other kind of violence? 3.1.Yes, I do face other kind of violence 3.2.Yes, I have ever faced other kind of violence 3.3.No, I don't face other kind of violence 3.4.No, I have never faced other kind of violence 4. Do you know any visually impaired woman who face or who has ever faced physical violence? 4.1. Yes, I know a visually impaired woman who face physical violence 4.2. Yes, I know a visually impaired woman who has faced physical violence 4.3. No, I don't know any visually impaired woman who face physical violence 4.4. No, I don't know any visually impaired woman who has ever faced physical violence 5. Do you know any visually impaired woman who face or who has ever faced any other kind of violence? 5.1. Yes, I know a visually impaired woman who face any other kind of violence 5.2. Yes, I know a visually impaired woman who has faced any other kind of violence 5.3. No, I don't know any visually impaired woman who face any other kind of violence 5.4. No, I don't know any visually impaired woman who has ever faced any other kind of violence

Thank you for your time, we appreciate your cooperation in the
European Blind Union project.

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