Anti-Gender-Based Violence Poetry Circle Curriculum Guide Survey

1. Anti-Gender Violence Poetry Circle Guide Registration Form

Thank you for your interest in receiving a copy of our poetry circle curriculum guide. Please complete the following information.

1. Please fill out the following demographic information. We are very interested in learning more about who is interested in our guide.

Please fill out the following demographic information. We are very interested in learning more about who is interested in our guide. Name:
Organization/School:
Address:
Address 2:
City/Town:
State:
ZIP:
Country:
Email Address:
Phone Number:

2. How did you hear about this guide?

How did you hear about this guide? Listserve Announcement

Organizational website

E-newsletter

Word of mouth

Other (please specify)

3. Have you used the "Something is Wrong: Exploring the Roots of Youth Violence" curriculum guide?

Have you used the "Something is Wrong: Exploring the Roots of Youth Violence" curriculum guide? Yes

4. Do you currently work with youth (ages 10 to 24)?

Do you currently work with youth (ages 10 to 24)? Yes

5. Why are you interested in receiving a copy of our new anti-gender-based violence poetry curriculum guide?

Why are you interested in receiving a copy of our new anti-gender-based violence poetry curriculum guide?

6. We are making this particular guide available to you at no cost and ask that the guide be used ONLY for educational purposes rather than for PAID workshops.

Do you agree to use the guide for educational purposes and at no cost to participants?

We are making this particular guide available to you at no cost and ask that the guide be used ONLY for educational purposes rather than for PAID workshops. Do you agree to use the guide for educational purposes and at no cost to participants? Yes

7. We want to keep track of who is requesting the guide. As such, we ask that you NOT distribute this guide to others. Feel free to direct other to us to receive their own copy of the guide.

Do you agree NOT to distribute this guide to others?

We want to keep track of who is requesting the guide. As such, we ask that you NOT distribute this guide to others. Feel free to direct other to us to receive their own copy of the guide. Do you agree NOT to distribute this guide to others? Yes

8. We are considering charging money for future curricula guides. Please tell us how much you think is fair to pay for curricula guides (please check one).

We are considering charging money for future curricula guides. Please tell us how much you think is fair to pay for curricula guides (please check one). All guides should be made available at no cost.

$10-24

$25-49

$50-74

$75-99

$100-124

$125-150

Other (please specify)

Anti-Gender-Based Violence Poetry Circle Curriculum GuideExit this survey

1. Anti-Gender Violence Poetry Circle Guide Registration Form

Anti-Gender-Based Violence Poetry Circle Curriculum Guide
Exit this survey