Share Your Thoughts about Send Silence Packing

Thank you for taking a few minutes to share your thoughts on Active Minds' suicide awareness display, Send Silence Packing. Please answer the brief questions below based on your experience viewing the display.

Your answers will be anonymous but at the end of the survey you will have the option to submit your email address (which will be kept separately from your answers) to be entered into a raffle to win a $25 gift certificate to Amazon.com. Your email address will be used for no other purpose than the raffle.

1. Please indicate today's date.

	MM		DD		YYYY
Today is:	Please indicate today's date. Today is: Month	/	Day	/	Year

2. What is your gender?

What is your gender? Female

Male

Transgender

Other

3. Please tell us who you are:

Please tell us who you are: Student Faculty	College or University staff Community member
Other (please specify)

4. Where did you see Send Silence Packing?

Where did you see Send Silence Packing? California State University - Chico in Chico, CA

United Nations Plaza in San Francisco, CA

California State University - Long Beach in Long Beach, CA

Alive & Running 5K in Los Angeles, CA

Pitzer College in Claremont, CA

Chapman University in Orange, CA

College of the Desert in Palm Desert, CA

Mt. San Jacinto College in San Jacinto, CA

University of California - Irvine in Irvine, CA

University of California - Riverside in Riverside, CA

University of Southern California (USC) in Los Angeles, CA

UCLA in Los Angeles, CA

I did not see a display of Send Silence Packing

Other (please specify)

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