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Backtrack Boys Audience Survey
1.
Do you identify as...
Female
Male
Non-binary / third gender
Prefer not to say
Prefer to self describe
2.
Which age group are you in?
Under 20
21-30
31-40
41-50
51-60
61-70
Over 70
3.
When did you attend a screening of Backtrack Boys?
Date
Date
January
February
March
April
May
June
July
August
September
October
November
December
1900
1901
1902
1903
1904
1905
1906
1907
1908
1909
1910
1911
1912
1913
1914
1915
1916
Su
Sunday
Mo
Monday
Tu
Tuesday
We
Wednesday
Th
Thursday
Fr
Friday
Sa
Saturday
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
4.
Which Screening did you attend (Venue, Town, State)?
5.
Has the film increased your awareness of experiences for young people who are having a hard time? Please rate
A great deal
A lot
A moderate amount
A little
Not at all
6.
Has the film increased your awareness of experiences for young people who are encountering the justice system and juvenile detention? Please rate
A great deal
A lot
A moderate amount
A little
Not at all
7.
Has the film changed your thinking in any way about the experience of young people who are having a hard time? Please rate
A great deal
A lot
A moderate amount
A little
Not at all
8.
Do you think you are likely to do any of the following after seeing this film?
Contact a decision maker in my community to talk about the film and the situation for young people
Find out about how I can participate in youth programs in my community
Find out ways in which I might be able to help young people in my community
Volunteer with a youth organisation or youth support service
Donate to BackTrack or other youth programs
Not likely to do anything
I’m inspired to do something else – can you please briefly explain?
9.
Do you want to see youth programs in your community take on a whole-of-community approach like the BackTrack program?
Yes
No
10.
Did you know about the BackTrack program before seeing the film?
Yes
No
11.
We’d love to stay in touch! Please let us know if you would like us to contact you (optional):
I’d like to host a screening in my community or workplace
I would like to receive email updates from BackTrack Boys the film
I would like to receive email updates from BackTrack the program
12.
Please leave us your details below and we will be in touch shortly (optional)
My name is
Email Address
Phone Number
13.
Please share any other comments you have below:
Current Progress,
0 of 13 answered
