Please answer Question 1 (story) OR Question 2 (checkbox) AND Question 3 (use consent).

 
Results of this survey will be used to create the linoprint artwork Paper Women by me (Amanda Firenze).  Individual responses will be printed to a paper woman, and then the women will be linked together to create the artwork, which will also be shared online (please opt out below if needed) and exhibited through means such as public exhibition, creation of artists' books and zines (not for profit only).  All responses are completely anonymous, can be in any language and no identifying information will be used.  I would love your words, but I can definitely work with your experiences (tick as many boxes as needed).  You are not alone and together we can empower ourselves, each other and change the world.    

For more information on me, please visit printchange.wordpress.com or my Facebook or Instagram pages.   To see examples of paper women, please visit the Paper Women Gallery.  To sign up to the Print Change newsletter please click here.  
 
Abuse information based on the Domestic Abuse Intervention Project, Duluth Minnesota, www.theduluthmodel.org.

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* 1. Tell me your story of abuse that you have suffered in as many or as few words as you like - nothing will be edited and your story will remain anonymous.

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* 2. If you don't wish to write,  please mark any of the below forms of abuse that you may have suffered.  Please note each of these forms of abuse has more details in questions below if you wish to give more information.

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* 3. Please indicate below if you DO NOT wish for your story / experience to be shared in the online artwork or used in women's events exhibiting the artwork such as Reclaim the Night.  

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* 4. Verbal abuse

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* 5. Physical abuse

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* 6. Psychological abuse 

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* 7. Emotional abuse

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* 8. Social abuse

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* 9. Financial abuse

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* 10. Sexual abuse

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* 11. Harassment and stalking

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* 12. Spiritual or religious abuse

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* 13. Reproductive abuse

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* 14. Image-based abuse

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* 15. Past child abuse

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* 16. Stranger abuse

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