EmailMe Form - PAC Membership Survey

Name *

First Last

Email *

Gender Pronouns *

Phone *

### - ### - ####

Address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

What do you hope to gain from your involvement with STAR's Prevention Action Coalition? (Select all that apply.)

(SV = Sexual violence)

Increased personal knowledge about SV (definitions, recent and reliable stats, dynamics, "rape culture," etc.) through community trainings and other informational resources

Skills for communicating effectively about SV

Increased personal knowledge about SV prevention

Access to resources to support institutions/organizations in preventing and reacting responsibly to instances of SV (e.g. sample policies and procedures, institution-specific resources)

Online/In-person interaction with others committed to reducing our community's prevalence of sexual violence

Awareness about meaningful prevention activities that can be implemented in various community settings

Building an institutional partnership between your organization and STAR

Other

In what primary capacity would you participate in the PAC?

Organizational representative

Individual/Concerned community member

Which of these groups or labels apply to you, your professional life, and/or your community involvement? (Select all that apply.)

Please submit any other comments, suggestions, or questions for us to consider.