For the Love of My Gurls Survey

Section 1

Thank you for helping us make sure For the Love of My Gurls is doing what it set out to do - educate, equip and empower women like YOU to prioritize #BlackBreastHealth. Your input will help save lives! Although your responses are confidential, this survey is not anonymous. Your continuation of this survey is your consent to participate and recontact.

By completing this survey (which should take about 5 minutes) you will be entered into a raffle to win a $100 gift card to Aerie! We’ll be pulling a winner every month!

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* 1. What is your email address?

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* 2. What is your phone number?

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* 3. What is your zip code?

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* 4. How old are you?

17 and under

18-22

23-28

29-35

36 or older

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* 5. What sex was originally listed on your birth certificate?

Female

Male

Decline to answer

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* 6. Have you ever had a breast cancer diagnosis?

Yes

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* 7. What is your ethnicity?

Hispanic or Latino

Not Hispanic or Latino

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* 8. What is your race? (Choose all that apply)

White

Black or African American

Hispanic or Latino

Asian or Asian American

American Indian or Alaska Native

Native Hawaiian or other Pacific Islander

Another race

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* 9. Where did you first see or hear the For the Love of My Gurls campaign? (Choose all that apply.)

At an In-person Event

On the Loveofmygurls.org Website

On Social Media (@loveofmygurls)

In an Article or Publication

On a Live Webisode

In Print Material

On the Radio

Other (please specify)