Audience Survey
Thank you for watching SURVIVOR MADE and filling out this short survey. Your responses help guide our impact campaign. If you are uncomfortable with a question, feel free to leave it blank.
Sign in to Google to save your progress. Learn more
Your Name
Your Organization
Your Email
Where did you watch SURVIVOR MADE?
Clear selection
Where do you currently live?
We'd love to hear from you! Please share your thoughts on SURVIVOR MADE. What stood out to you about the film, and how did it make you feel?
After watching SURVIVOR MADE, I have a better understanding of: (Select all that apply)
After watching SURVIVOR MADE, I feel inspired to: (Select all that apply)
In your opinion, does SURVIVOR MADE differ from other films or media that explore gender based violence? If so, in what way(s)?
OPTIONAL: Only respond if this applies to you and you want to share.

I have been subjected to gender-based violence, and after watching SURVIVOR MADE, I feel:
Can we include your responses in our impact campaign? Our film celebrates community, and we’d love to share these stories with your voice!
Clear selection
Survivor-entrepreneurs, join the GIFTED community! Check the box to learn more about selling on GIFTED.
Would you like to join our newsletter?
Clear selection
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of FreeFrom.

Does this form look suspicious? Report