World Wide Survey

Please fill out my questionnaire, the results of which will be published here and presented to all governments in the appropriate language. My intent is to show the extent of abuse on a global scale and the lack of services available, along with a petition for radical improvements to the judicial system and the length of sentence given.

All information given will be treated in the strictest of confidence. All information given will be used for the purpose of encouraging governmental activism.....nothing else. Thanks.

Please tell me your name: (Do not hit return) (optional)

Please tell me the area you come from:

Please tell me your occupation:

1) How old are you?

Under 18 years old

Between 19 and 24 years old

Between 25 and 34 years old

Between 35 and 44 years old

More than 45 years old

2) How often do you visit my page?

Every Day

Once per week

Once per month

Once per year

3) Please indicate the type of abuse you have suffered?

Incestual

Sexual

Physical

Emotional

4) Do you go to any of the following?

Therapy

Counselling

A Self-Help Group

A #Survivors Channel

5) Have you reported the abuse

Yes

No

6) Are you likely to report the abuse in the future?

Yes

No

Not Sure

7) Do you feel as a survivor of abuse that you receive enough support?

Yes

No

8) Please say what changes you feel are needed to help survivors through the healing process.

Page Design : Jill Miles

Background: Robyn Cowley Biar

ArtWork: Jill Miles

(or borrowed from other sources on the net)