S.T.A.N.D. ASA Survivor Collective Questionnaire

Name

First Name

Last Name

Phone

(###)

###

####

Where did you hear about this communtiy outreach?

When did your sexual assault occur?

(a time range - childhood / adult / late adult)

Do you have any triggers we need to be aware of?

Are you comfortable with having your voice recorded before your photos are taken about your story?

Makeup and hair styling will be provided and we need to plan accordingly, do you have short hair or long hair?

If you are chosen for this public outreach, are you comfortable with others seeing the images chosen online and at the art gallery viewing?