Please Read Instructions Before Proceeding

* 1. The purpose of this research project is to obtain information to help develop anti-rape strategies in African American/Black communities. This is a research project being conducted by Black Women's Blueprint. Your participation in this research study is voluntary. The procedure involves filling an online survey that will take approximately 5 minutes. Your responses will be anonymous and we do not collect identifying information such as your name, email address or IP address. The results of this study will be used for scholarly purposes only and for community organizing purposes. If you have any questions about the research study, please contact

ELECTRONIC CONSENT: Please select your choice below.
Clicking on the "agree" button below indicates that: You have read the above information, you voluntarily agree to participate, you re at least 18 years of age

* 2. Zip Code?

* 3. How Old Are You?

* 4. Gender?

* 5. Race?

* 6. What Is Sexual Assault?

* 7. Have You Ever Been A Victim Of Sexual Assault?

* 8. Was the person Black?

* 9. Age When Assault Occurred?

* 10. Have You Ever Sexually Assaulted Someone?

* 11. Why Does Sexual Assault Happen In Our Black Communities?

* 12. What Would It Take To End Sexual Assault in Our Black Communities?

* 13. RESOURCES: (Kisa Healing Blog)
Contact: 347-533-9102 (Mon-Fri 10am-6pm est)
The Black Women's Blueprint Hotline: 646-647-5414

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