Please Read Instructions Before Proceeding

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* 1. TELL YOUR STORY

This narrative is being gathered for the Black Women’s Truth and Reconciliation Commission of Black Women's Blueprint. The purpose of this initiative is to give voice and obtain information to help develop anti-rape strategies and strategies to prevent sexual assault and sexual abuse in Black/African American communities in the U.S. This project was conceived and developed using a Critical Participatory Action model. "Participatory Action Research (PAR) is a more activist approach. PAR is an approach to community narratives that values the significant knowledge people hold about their lives and experiences. PAR positions those most intimately impacted by research as leaders in shaping research questions, framing interpretations, and designing meaningful research products and actions" (The Public Science Project).

Your participation in this project is voluntary. The procedure involves filling an online form. Your responses will be anonymous and we do not collect identifying information such as your name, email address or IP address. The narratives collected from this initiative will be for community organizing, human rights advocacy, Black women’s history archiving and scholarly purposes.

If you wish to engage further in this work, you may choose to complete additional information. Completing this information is voluntary and is not required. If you have any questions about the initiative, please contact BlackWomen@blueprintny.org

ELECTRONIC CONSENT: Please select your choice below.
Clicking on the "agree" button below indicates that: You have read the above information, you voluntarily agree to participate, you re at least 18 years of age.

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* 2. Zip Code?

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* 3. How Old Are You?

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* 4. Gender?

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* 5. Race/Ethnicity?

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* 6. In Your View, What Is Sexual Assault?

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* 7. Have You Ever Been Sexually Assaulted?

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* 8. Was The Person(s) Who Assaulted You Black?

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* 9. Age or Each Age When Assault Occurred?

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* 10. You Can Speak Your Truth Here And Tell Your Story Of What Happened To You.

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* 11. In Your View Why Does Sexual Assault Happen In Our Black Communities?

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* 12. Have You Ever Sexually Assaulted Someone?

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* 13. What Would It Take To End Sexual Assault in Our Black Communities?

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* 14. Please Share About How Sexual Assault Has Affected Your Life, Ability To Work, Finish School, College, Etc.

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* 15. Would You Like To Be Involved In This Project In Any Other Way? If So, You May Choose To Include Your Email Address Or Other Contact Information Below (Optional) And Confidential.

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* 16. RESOURCES:
IF YOU NEED SUPPORT: You can choose to join our Free Weekly Online Trauma Support Group for Survivors of Sexual Assault/Abuse. Joining a optional and your choice. To link to the online, interactive support group, Sign Up at Sister Circles
To talk to someone, you may contact: 347-533-9102 (Mon-Fri 10am-6pm est)
For questions, comment or additional assistance, email: BlackWomen@blueprintny.org
Get more resources and information at Black Women's Blueprint

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