Gun Violence Experience Survey
As a part of the 2021 Outreach agenda, the committee is reaching out to members who belong to communities affected by gun violence to amplify the voices of those who have personally been affected.
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Email *
Name ( First, Last ) *
Age *
School District, if a student. If you attend a college or university, you can answer this question with its name.
Neighborhood / Community *
Are you comfortable sharing additional information about your personal experiences? (If you select no, the form will end.) *
Are you comfortable with your experience being shared in a MFOLH publication? (We will contact you beforehand about how your information will be shared and to confirm your participation if you select yes or maybe. c: )
Clear selection
Would you like to remain anonymous? Leave an alias under "other" if preferred.
Clear selection
Please use this section to share information on how the event(s) have impacted you or your affected community.
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