Questionnaire for acid attack survivors living in the US
RISE is a US-based 501c3 nonprofit working to end acid violence in the United States and internationally. We provide hope and support to acid attack survivors and collaborate with survivor organizations around the world. While our initial mission was to support the growth of acid attack centers internationally, we have realized there are many acid attack survivors living in the US in need of support. But: we need to do some research first to better understand how we might help. Please fill out this questionnaire to help us get to know you better. If you have any questions about RISE, feel free to check out our website at
or email us at
What is your name?
Where in the U.S. do you live?
What services or resources for acid attack survivors in the US do you think are lacking?
General awareness about acid violence
If you selected "other" in the previous question, please list what other resources you feel are lacking.
We’d love to learn more! May our RISE board member Heike Roberson, who is also an acid attack survivor, contact you to discuss more details? If so, please leave us your email address and phone number so that we can contact you.
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. -
Terms of Service