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What is your first and last name?
What are your pronouns? Choose all that apply.
She/her
He/him
They/them
Other
What is your racial and ethnic identity? Choose all that apply.
White
Black
Asian or Asian American
Latinx and/or Hispanic
Other
Which of the following best applies to you?
Both of my parents were born in the United States
One of my parents was born in the United States
None of my parents were born in the United States
Which of the following best applies to you and your family?
One or more of my parents graduated high school
One or more of my parents holds an Associate's degree
One or more of my parents holds a Bachelor's degreee
One or more of my parents holds a graduate degree (MA, MS, PhD, MD, JD, etc.)
None of the above
Do you have experience with sexual misconduct in a post-secondary educational setting (i.e. as an undergraduate or graduate student and in a setting related to your degree, such as in lab, at a department event, or at a conference)?
Yes
No
Did this experience take place when you were pursuing a:
BA or BS
MA / MS
PhD
MD or other medical degree
JD
What is the name of this institution? Your institution will not be identified by name in the final product, but by a pseudonym.
Were you over the age of eighteen (18) at the time of your experience?
Yes
No
Are you currently over the age of eighteen (18)?
Yes
No
Are you interested in participating in a one time interview (1.5 to 2 hours) for this project?
Yes
No
What is your email address?
What is your phone number?
How do you prefer to be contacted?
Email
Phone call
Text
What is your time zone?
Eastern
Central
Mountain
Pacific
What time of day do you prefer to be contacted (Monday through Friday)?
Morning (9 AM to 12 PM in your time zone)
Afternoon (12 PM to 5 PM in your time zone)
Evening (5 PM to 9 PM in your time zone)
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