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Gun Violence Experience Survey
As a part of the 2021 Outreach agenda, the committee is reaching out to members who belong to communities affected by gun violence to amplify the voices of those who have personally been affected.
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* Indicates required question
Email
*
Your email
Name ( First, Last )
*
Your answer
Age
*
Your answer
School District, if a student. If you attend a college or university, you can answer this question with its name.
Your answer
Neighborhood / Community
*
Your answer
Are you comfortable sharing additional information about your personal experiences? (If you select no, the form will end.)
*
Yes
No
Are you comfortable with your experience being shared in a MFOLH publication? (We will contact you beforehand about how your information will be shared and to confirm your participation if you select yes or maybe. c: )
Yes
No
Maybe
Clear selection
Would you like to remain anonymous? Leave an alias under "other" if preferred.
Yes
No
Other:
Clear selection
Please use this section to share information on how the event(s) have impacted you or your affected community.
Your answer
Send me a copy of my responses.
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