Mashruuca Muuqaalka Xuquuqda Aadanaha ee Gobolka Sonoma

Foomka Warbixinta

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* 1. Yaad u warramaysaa?

Waxaan ka waramayaa dhacdo igu dhacday.

Waxaan ka waramayaa dhacdo aan goobjoog u ahaa.

Waxaan ka warbixinayaa dhacdo qof aan awoodin inuu sameeyo warbixintiisa.

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* 2. Please indicate your zip code of residence

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* 3. Fadlan sheeg jinsiyaddaada ama qofka aad u warramayso (sax dhammaan inta khuseysa):

Hindida Mareykanka ama Dhaladka Alaska

Madow ama Afrikaan Mareykan ah

Isbaanish ama Latinx

Aasiyaan ama Aasiyaan Mareykan ah

Dhaladka Hawaii ama Jasiiradaha Baasifigga ee kale

Bariga Dhexe

Yurubiyaan Mareykan ah

Fadlan cadee aqoonsigaaga dhaqan (tusaale ahaan, Ereteriya, Filibiin, Guatemala, Iiraan, Kuuriya, iwm)

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* 4. Fadlan sheeg jinsigaaga iyo / ama aqoonsigaaga jinsi (calaamadee dhammaan kuwa ku habboon):

Dheddig

Lab

Laba Ruux

Jinsiga

Aan binary ahayn

Wax kale (fadlan sheeg)

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* 5. Fadlan sheeg da'daada

Kayar 18 sano

18-24

25-34

35-44

45-54

55-64

65+

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* 6. Fadlan sheeg haddii mid ka mid ah duruufahaas ay sharraxayaan adiga ama qofka aad u warramayso (calaamadee dhammaan kuwa khuseeya):

Waxaan ahay qaata DACA

Waxaan ahay shaqaale beeraha

Waxaan la kulmayaa hoy la’aan

I am a member of the LGBTQIA2S+ community

Waxaan ahay qof naafo ah

Waxaan ahay dukumiinti

I am a veteran or member of the U.S. Armed Forces

Wax kale (fadlan sheeg)

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* 7. Taariikhda dhacdada

Taariikh / Waqti

Date

Time

AM/PM

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* 8. Address of occurrence

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* 9. Goobta ay ka dhacday

Jeelka weyn

Ganacsi

Hay'ad waxbarasho

Daryeelka Ilmo Korsiga

Hay'adda dowladda

Guri kooxeed

Xarunta Caafimaadka

Hoy hoylaawe ah

Hoolka Carruurta

Ilaalinta wadooyinka ee ilaalinta sharciga

Joojinta taraafikada taraafikada

Goobta shaqada

Waaxda Booliska

Gaadiidka Dadweynaha

Degenaansho

Hoyga daryeelka guryaha

Wax kale (fadlan sheeg)

Mashruuca Muuqaalka Xuquuqda Aadanaha ee Gobolka Sonoma

Foomka Warbixinta

Question Title

* 1. Yaad u warramaysaa?

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* 2. Please indicate your zip code of residence

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* 3. Fadlan sheeg jinsiyaddaada ama qofka aad u warramayso (sax dhammaan inta khuseysa):

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* 4. Fadlan sheeg jinsigaaga iyo / ama aqoonsigaaga jinsi (calaamadee dhammaan kuwa ku habboon):

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* 5. Fadlan sheeg da'daada

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* 6. Fadlan sheeg haddii mid ka mid ah duruufahaas ay sharraxayaan adiga ama qofka aad u warramayso (calaamadee dhammaan kuwa khuseeya):

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* 7. Taariikhda dhacdada

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* 8. Address of occurrence

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* 9. Goobta ay ka dhacday

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* 10. Fadlan ka dooro mawduuc hoosta tabta hoosta oo sida ugu fiican u sharraxaysa dhacdadaada xuquuqda aadanaha:

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* 11. Please describe what happened.

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* 12. Please describe the impact that this had on you.