Please Read Instructions Before Proceeding

* 1. This is a research project being conducted by Black Women's Blueprint. The purpose of this research project is to obtain information to help develop anti-rape strategies in Black/African American communities. This survey was conceived and developed using a Critical Participatory Action model. "Participatory Action Research (PAR) is a more activist approach. PAR is an approach to research that values the significant knowledge people hold about their lives and experiences. PAR positions those most intimately impacted by research as leaders in shaping research questions, framing interpretations, and designing meaningful research products and actions" (The Public Science Project).

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 or Each 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. Anything else you'd like to share about how sexual assault has affected your life, ability to work, finish school, college, etc. You can speak your truth here and tell your story of what happened to you. (optional)


To talk to someone, you may contact: 347-533-9102 (Mon-Fri 10am-6pm est)
The Black Women's Blueprint Hotline: 646-647-5414
For questions, comment or additional assistance, email:
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