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East New York Voices from the Community Story Project
Your story! You're East New York!
Thank you for your interest in the East New York Voices from the Community Story Project a video series that gathers personal narratives, stories and history about you and East New York. The stories are presented through the lens of people who live in the community, using written submissions, pictures and interviews to produce an engaging video series to tell our story. You can submit up to five photos to accompany your story. Note: All photos submitted may not be used. Photos can be submitted to: brownsvillestorytellingproject@gmail.com
To be a part of this project I am not required to be videotaped. The final recording will be available and viewed by the general public. I have the choice to use my first and last name or only my first name. If I submit photos to be used in this project they will be used only for this project all photos I submit may not used.
Demographic Information
Name:
Your answer
Address:
Your answer
Zip Code: *
Your answer
Primary Phone#:
Your answer
E-mail: *
Your answer
Languages Spoken other than English:
Age:
You Are:
Describe how you identify (select all that apply):
Your story! You’re East New York!
Please complete the following questionnaire:
Claim to Fame:
Your answer
Motto:
Your answer
How long have you lived in East New York?
Your answer
What do you admire most about East New York?
Your answer
What do you think makes East New York important?
Your answer
What is your favorite place to go in the neighborhood?
Your answer
What services or programs would improve health and wellbeing in East New York?
Your answer
Do you feel discriminated against or treated unequally in East? New York
How does this compare to other neighborhoods?
Your answer
Why?
Your answer
What do you think is the biggest challenge facing the East New York?
Your answer
What would you do to solve this challenge?
Your answer
What does safety mean to you?
Your answer
As a resident of East New York, do you feel safe?
Why or why not?
Your answer
What do you want people who don’t live in East New York to know about the neighborhood?
Your answer
What would you say to someone who is thinking about taking a more active role in their community?
Your answer
What do you want people to know most about you?
Your answer
If you could describe yourself in one sentence, what would it be?
Your answer
What does healthy living mean to you?
Your answer
Is there a particular moment or memory that stands out for you?
Your answer
Is there anything else you would like to share?
Your answer
Is there any question that you think should have been ask and was not?
Your answer
I am the person named above and am 18 years of age or older. I have read and understand the project description provided with this form, and my signature below confirms that conditions of my consent to be videotaped have been explained to me, and I understand agree to the following:
Signature *
Your answer
Date:
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