Media Impact Survey For Families Affected By Police Brutality
Have you or your loved one’s story been ignored, misrepresented, or mishandled by the media? Have news stations failed to listen, report accurately, or correct misinformation? Have you felt silenced or blackballed when speaking out against police brutality?
We want to hear from YOU. Your voice matters, and your experience can help expose media bias and demand accountability.
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Section 1: General Information
Referral Code
Name
Relationship to the Victim
City/State
Incident Date
MM
/
DD
/
YYYY
Section 2: Initial Media Coverage
How soon after the incident did the media begin covering your story?
Did you or your family reach out to media outlets, or did they reach out to you first?
Other, please specify:
What type of media covered did your case initially receive?  (Select all that apply)
Clear selection
If Other, please specify:
In the early coverage, what aspect of the story was most emphasized?
Other, please specify:
Did the initial coverage include any misinformation or biased narratives?
If yes, please specify:
Section 3: Ongoing Media Interactions
How would you rate the accuracy of the media coverage?
Did the media include your family's perspective in their coverage?
Have you or your family been contacted by reporters without consent or notice?
How often have media outlets followed up on your case since the initial coverage?
Do you feel the level of coverage has been adequate over time?
Have you or your family received support from journalists in navigating media coverage?
Did you receive guidance or assistance in preparing statements or handling interviews?
Have you encountered challenges in controlling how your story is shared?
If yes, please explain:
How comfortable do you feel speaking to the media?
Did you feel pressured by media outlets to share certain information or behave in a certain way?
Have any media outlets sensationalized or mispresented your family's story?
If yes, please describe how:
Section 4: Emotional Impact of Media Coverage
How has media attention affected your emotional well- being?
What emotions best describe how you feel about the media coverage of your loved one's story? (Check all that apply)
Clear selection
If other, please specify:
Have you experienced any harassment, threats, or backlash due to media attention?
Clear selection
If other, please specify:
Has media coverage impacted your mental health or well-being?
Clear selection
Section 5: Media's Role in Advocacy
Did media coverage help amplify your calls for justice?
How has media coverage impacted public awareness of your case?
Have you used social media platforms to share your story?
If yes, which platforms have been most effective for advocacy?
Clear selection
If other, please specify:
Did the media help connect you with other impacted families or advocacy groups?
Do you feel the media covered your story respectfully?
If no, please explain:
Section 6: Feedback
What would you like the media to do differently when covering cases of police brutality?
Are there specific journalists or outlets you found particularly supportive or harmful?
Additional comments or suggestions:
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