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* 1. Please rate Poverty, Inc.

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* 2. Where did you see the film? (City, State)

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* 3. First Name

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* 4. Last Name

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* 5. Email

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* 6. Which age group do you fall into?

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* 7. List the organization, business, or university are you affiliated with.

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* 8. How likely are you to recommend this film to a friend or colleague?

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* 9. After watching the film, I learned something new about poverty and its root causes.

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* 10. The film will influence my charitable behavior in the future.

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* 11. Which scenes most resonated with you? (Check all that apply)

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* 12. How has watching Poverty, Inc. inspired you to get involved? (Check all that apply)

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* 13. OPTIONAL: Leave a short review of the film that we can publicly share on our social media. (Only leave a review if we have your permission to share your review publicly.)

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* 14. OPTIONAL: Do you have people or organizations who might love this film? If yes, list them here, and we’ll reach out to you to get connected with them.

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* 15. OPTIONAL: Additional thoughts? Private feedback or comments for the film team?

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