Fatherless by Suicide Participation Form

Thanks for your interest in collaborating with me. If you lost your father to suicide and are interested in participating in this storytelling project, please fill out this form. I will contact you as soon as I can to discuss the project and explore your potential participation.

Lastly, please know I will not share your information with anyone else.

Thanks and I look forward to speaking soon,

First name *
Your answer
Last name
Your answer
City *
Your answer
State *
Your answer
Email address *
Your answer
Phone number
Your answer
Your age
Your answer
The age when your father passed
Your answer
Are you willing to be interviewed as part of this project? *
Note: All interviews will be recorded with an audio recording device
As part of this project, I will take photo portraits of each of us holding something of our fathers (if we have something, or a portrait without). Would you be interested in taking part in the portrait series? *
Please share any information about your hopes for participation or questions you may have.
Suggestions or ideas are encouraged.
Your answer
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