Please, help us on our mission to make the world a better place.
An anonymous survey to gather data on women’s experiences of assault.
Sign in to Google to save your progress. Learn more
What age were you at the time of your attack? *
Required
What type of assault/attack you have experienced? *
Required
Please share with us the location of your assault/attack. *
Required
Please share more details about this location. Country, city, street, neighborhood, area; any information can help to locate this on a map *
If you would like to be updated about our development and status, please leave us your mail.
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy