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* 1. Which state/territory did you host the film in?

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* 2. Town and venue

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* 3. Name of event and organisation (if applicable)

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* 4. Screening type:

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* 5. Please provide information on your screening purpose and objectives

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* 6. Number of attendees at the screening

0 200
i We adjusted the number you entered based on the slider’s scale.

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* 7. Did any of the following attend the screening? 

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* 8. Your screening

  Yes No
Was there a Q&A discussion?
Were you raising funds for BackTrack?
Were you raising funds for your organisation or another initiative?

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* 9. Now that the screening is over, to what extent do you agree or disagree that:

  Disagree Neutral Agree
Your objectives for holding the screening were met
The Screening and Discussion guide was useful
The screening facilitated conversations about the issues in the film
New connections were made between people or organisations
The screening will lead to future action and change
It would be beneficial to screen the film again

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* 10. Were there any other outcomes as a result of the screening? (e.g. social media engagement, volunteers with your organisation, etc)

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* 11. After this screening, to what extent do you agree that documentaries have the power to affect social change?

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* 12. Do you know who Documentary Australia Foundation are?

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* 13. What do you think the most significant change has been as a result of the screening?

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* 14. Do you have any anecdotal feedback or testimonials from the audience that you can share?

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* 15. Please attach any photos, media or other documentation from your screening 

DOCX, DOC, JPEG, GIF, JPG, PDF, PNG file types only.
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* 16. Following on from the screening please rate whether the film has:

  Disagree Neutral Agree Not sure
Improved understanding of youth issues
Increased awareness of alternatives to juvenile detention
Inspired people to take action (e.g. donate, volunteer, share the film) 
Changed community conversations on approaches to youth issues
Lead to new youth programs or approaches
Been a training and educational tool (e.g. for youth and people working with them) 
Empowered young people to seek help
Provide youth involved in juvenile justice with a positive view of themselves

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