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)

Jill Miles (paddy)
Copyright 1997 [#Survivors On The Net]. All rights reserved.
Last revised: