Thank you for considering sharing your story with the National Domestic Violence Hotline (The Hotline) and our prevention program love is respect. We are inspired by the strength of survivors every day, and we hope to use the stories we collect to spread awareness about intimate partner violence across the country.

Stories are among the most powerful tool we use in public communications, whether that be on social media or in media interviews or in legislative testimony. We will not share your name or any part of your story that would be identifying without asking for permission to do so. Thank you for sharing your story with us, and thank you for showing anyone currently experiencing intimate partner violence that they are not alone.

If you need help, please contact The Hotline directly at 1-800-799-7233 or chatting at thehotline.org

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* 1. Have you ever used The Hotline or love is respect for direct services before?

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* 2. If yes, what service(s) did you use?

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* 3. If you feel comfortable in sharing, please indicate any forms of abuse that you have experienced. Please select all that apply:

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* 4. Please share your story with us. The trauma survivors experience is very real. We want to be sure that sharing your story will not be re-traumatizing for you, so please only share the information and details that feel right for you to share.  (800 word limit)

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* 5. Our Advocates are dedicated to supporting people affected by relationship abuse 24/7. It is your strength that inspires them to do this work every day. Is there anything you’d like to tell our Advocates? (200 word limit)

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* 6. We’d like to reach out to you if we have any questions about your story, or if we’d like to use your story publicly. Please only share this information if it is safe for you to do so. If you are alright with this, please share:

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* 7. How do you identify?

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* 8. What is your ethnicity?

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* 9. What age range best describes you?

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