We are looking for feedback from survivors of domestic violence of any age, gender, sexual orientation, or other identity. We want to hear from you other people and/or organizations were helpful to you and also how they were not helpful.

This information is intended to inform the recommendations that Walnut Avenue makes to the community about how to respond as allies, as well as any changes that Walnut Avenue makes to its own policies or services.

This form is anonymous.

Question Title

* 1. Do you live in Santa Cruz County?

Question Title

* 2. What did other people and/or services provide that was helpful to you as a survivor of domestic violence?

Question Title

* 3. What could other people and/or services have done better in supporting you as a survivor?

Question Title

* 4. If you ever used any of Walnut Avenue's services and they were helpful, will you explain how they were helpful?

Question Title

* 5. Would you like to add anything else regarding your experience as a survivor and how your community did or did not support you?

Release of Information

If you agree to this release of information, Walnut Avenue may choose to publicly quote your responses to any of the questions above. It is for educational purposes so that anyone viewing our social media or other materials may see the responses in a survivor's own words.

If you do not agree to this release of information, then we will not quote any of your responses.

Question Title

* 6. Do you agree to allow Walnut Avenue to quote any of your responses for educational purposes?

Thank you!

T