Survey


Name: *

Email: *

Phone: *

Birthdate: *


I identify as female.
Yes No

What is your self-identified gender?
Female Male Other (please specify)


Race:


Which of the following best describes your marital status?
Single Married Separated Divorced Widowed



Which of the following best describes your sexual orientation?
Asexual Bisexual Heterosexual Lesbian Questioning Transgender Transexual Heterosexual Prefer not to say Other (please specify)


Have you experienced any of the following types of abuse?
Sexual Abuse Fincancial Abuse Sexism Emotional Abuse Immigration Abuse
Spiritual Abuse Heterosexism Physical Abuse Homophobia Use of Children

If you checked any of the above boxes, click HERE for help resources.


If you checked anything above, how old were you when you first experienced any of the above.*





Do you know someone who has experienced any of the above options? *




What color do you associate with feminism?



Describe feminism in your own words.