lo2

<% sub MailResponse dim message, temp message = message + "County:" & Request("county") & vbCRLF message = message + "Town:" & Request("town") & vbCRLF message = message + "Age:" & Request("age") & vbCRLF message = message + "Sexuality:" & Request("Sexuality") & vbCRLF message = message + "Were you sexually abused as a child?:" & Request("abused") & vbCRLF message = message + "If it were a single event, how old were you?:" & Request("age2") & vbCRLF message = message + "Started:" & Request("started") & vbCRLF message = message + "Ended:" & Request("ended") & vbCRLF message = message + "Was your abuser?:" & Request("abused1") & vbCRLF message = message + "Was your abuser a?:" & Request("groups") & vbCRLF message = message + "Where did the abuse occur?:" & Request("occur") & vbCRLF message = message + "Comments:" & Request("add") & vbCRLF message = message + "Were you sexually assaulted as an adult (17 or over):" & Request("adult") & vbCRLF message = message + "Your age at time of assault:" & Request("age3") & vbCRLF message = message + "How many assailants were involved?:" & Request("number") & vbCRLF message = message + "Was your assailant:" & Request("assailant") & vbCRLF message = message + "Was the assailant?:" & Request("friend") & vbCRLF message = message + "How many times:" & Request("times2") & vbCRLF message = message + "Where did the assault occur?:" & Request("occur2") & vbCRLF message = message + "Comments:" & Request("add2") & vbCRLF message = message + "Have you been raped?:" & Request("raped") & vbCRLF message = message + "Your age at time of rape?:" & Request("age4") & vbCRLF message = message + "How many rapists were involved?:" & Request("number2") & vbCRLF message = message + "Was your rapist:" & Request("assailant2") & vbCRLF message = message + "Was your rapist a?:" & Request("assailant3") & vbCRLF message = message + "Have you been raped more than once, if so how many times?:" & Request("times3") & vbCRLF message = message + "Where did the rape occur:" & Request("where") & vbCRLF message = message + "Comments:" & Request("add3") & vbCRLF message = message + "Have you had any contact with a Helpline specifically dealing with male abuse?:" & Request("helpline") & vbCRLF message = message + "Have you received any form of Counselling for your abuse?:" & Request("counselling") & vbCRLF message = message + "Was the abuse/rape reported to the police?:" & Request("police") & vbCRLF message = message + "Comments:" & Request("add4") & vbCRLF message = message + "Submit Status:" & Request("Submit Status") & vbCRLF Set objEmail = Server.CreateObject("CDONTS.NewMail") objEmail.To = "enquiries@mankinduk.co.uk" objEmail.From = "Census@mankinduk.co.uk" objEmail.Subject = "Census Feedback" objEmail.Body = message objEmail.Send Set objEmail=Nothing if Err.number <> 0 then Response.Write "There was an error sending the message.
Please try hitting the 'Backspace' button on your keyboard and resubmit." else Response.Write "Thank you for helping us by completing this census." end if end sub sub DisplayForm %>

Confidential

National Census Sheet on Male Sexual Abuse.
(Census to be completed by Men of 17 years and over who have experienced, at some time in their life, sexual abuse and/or rape).



Which county do you reside in?:

Town/City:

What is your age now?

What is your sexuality?

Were you sexually abused as a child?	Yes No

If it were a single event, how old were you?

If the abuse occurred over a period of time, how old were you when the abuse:	started: ended:

Was your abuser:	Male Female Both

Was your abuser a:

Where did the abuse occur:

Is there anything you would like to add?

Were you sexually assaulted as an adult (17 or over):	Yes No

Your age at time of assault:

How many assailants were involved?

Was your assailant:	Male Female Both

Was the assailant?

Have you experienced more than one event of sexual assault, if so how many times:

Where did the assault occur?

Is there anything you would like to add?

Have you been raped?	Yes No

Your age at time of rape?:

How many rapists were involved?

Was your rapist:	Male Female Both

Was your rapist?

Have you been raped more than once, if so how many times?

Where did the rape occur?

Is there anything you would like to add?

Have you had any contact with a Helpline specifically dealing with male abuse?

Have you received any form of Counselling for your abuse?	Yes No

Was the abuse/rape reported to the police?	Yes No

Is there anything you would like to add?

Thank you for helping us by completing this census.

<% end sub %> lo2

<% if Request("Mode") <> "" then MailResponse else DisplayForm end if %>