Girl ImPowered Survey

www.girlimpowered.com

Hello! Thank you so much for taking 3 quick minutes to tell us how Girl ImPowered can help you and your daughter gain confidence. The questions are for both Moms and daughters. Your name will be instantly entered to win a $50 Visa card. There will be MULTIPLE winners so your odds are GREAT!

Question Title

* 1. Do you have any daughters between the ages 12-17?

Yes

I have a daughter older than 17 years old

I have a daughter younger than 12 years old

First a few questions about your daughter...

Question Title

* 2. Has your daughter ever participated in any activities outside school? Check all that apply.

Girl Scouts

Girls on the Run

STEM (science, technology, engineering math)

Music- Band, Orchestra, Chorus, Theater, etc.

Dance

Cheer

Art

Sports

List another activity below.

Question Title

* 3. What are your daughter's biggest struggles? Check all that apply.

School Work

Making Friends

Body Image

Social Isolation/ Bullying

Stress

Organization/ Life Skills

Peer Pressure

Other (please specify)