V2V Advisory Council

Name *

First Name

Last Name

Phone

(###)

###

####

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Which Social Media Platforms Do You Use? *

select all that apply

Twitter

Instagram

Facebook

Snapchat

Tik Tok

Other

None

Are Your Social Media Accounts Private? *

If yes, we may ask to follow or friend you to verify your identity.

Yes

No

Which Most Accurately Describes Your Experience with Abuse? *

Domestic Violence

Rape

Emotional/Verbal Abuse

Manipulation/Coercion

Molestation/Child Sexual Abuse

Other

Did You Report It? *

No judgement here we need to hear from women that have and women that haven’t reported.

Yes

No

Which of the following tags best describes where you are right now? *

In It (I'm still in my abusive situation)

Preparing To Leave (I know I need and want to go- but I have to plan first)

Out and Recovering (I've made it out and now I'm figuring out how to put the pieces back together

Out and Thriving (I made it out, I've picked myself up, and I'm living my best life)

This council is not public, our communications are private, and our meetings are only open to fellow members. With that said, are you putting yourself at risk by participating? ie. If someone checks your texts or emails would being in this group cause problems for you? *

Yes

No

We need women who have owned that abuse is part of their story but also know that the abuse does not define them. Before now, have you shared about your experience with abuse? *

Yes

No

Are you willing to share your story in this council so that your experience can be used to help guide others going through a similar experience? *

Yes

No

Can you commit to making yourself available for quarterly virtual meetings? *

Yes

No

Are you comfortable giving honest feedback via survey or zoom focus group? *

Yes

No