Fort Garry Women's Resource Centre (FGWRC) Survey

1.Name:(Required.)

First Name:

Last Name:

2.Phone Number:(Required.)

3.Email:(Required.)

4.Story/Testimonial:(Required.)

5.Thank you for sharing your story. Please let us know if we have permission to share your story with people who are interested.(Required.)

I permit FGWRC to share my story (on our website, social media, newsletter, print, etc.)

I do not permit FGWRC to share my story.

6.If we have permission to share your story, how would you like to be identified?(Required.)

Use my full name.

Use only my first name.

Do not use my name (FGWRC will either choose an alternate name or anonymous).

7.Would it be okay if a FGWRC staff member reached out to you?(Required.)

Yes

NO

Fort Garry Women's Resource Centre (FGWRC)