Basic Information

Thank you for sharing your story. Please be sure to practice self-care and connect with your local rape crisis center if you need to. You can find their contact information here. You can also find the contact information of some culturally specific programs by clicking here. We will use the information collected here to compile statistics and other relevant information on the prevalence of sexual assault in the state of New York and/or on its residents (if you reside in NY State, but your victimization occurred outside of NY). We will not include any names in our analysis.

We will also use this information to inform our prevention and intervention efforts against sexual violence and sexual abuse. In addition to that, we will also use this information in our policy education and advocacy efforts.

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* 1. Do you identify as a victim or survivor of sexual violence?

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* 2. What is your gender?

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* 3. What is your race?

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* 4. What is your zip code?

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* 5. Were you victimized while attending college in New York State (including community college, undergraduate institutions, law school, dental school, or technical college)? 

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* 6. Were you victimized in a correctional facility in New York State?

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* 7. Were you victimized while serving in the military?

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* 8. Were you victimized outside of the aforementioned systems (college, prison, and/or the miliary)?

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