BLINK: A Gun Violence Prevention Film
Audience Survey
Date Film Viewed
-
Month
-
Day
Year
Date
Age
0-11
12-14
15-18
19 and up
Gender
Male
Female
I Prefer Not to Answer
Please rate your level of satisfaction on this film on a scale of 1 to 5 stars (5 Being the Highest)
1
2
3
4
5
What did you like about this short film?
Is there anything you did NOT like about this short film?
Would you watch this film again and/or recommend this short film to someone else?
Yes
No
I'm Not Sure
Why or why not?
Who do you think the film is meant to reach?
Do you think this film depicts what is happening in our community?
Yes
No
I'm Not Sure
What is your favorite scene/moment of this short film and why?
Should this film be shown in schools?
Yes
No
I'm Not Sure
If you selected yes, to the previous questions, where should it be shown (select all that apply)?
Elementary School
Middle School
High School
Is gun violence something that concerns you?
Yes
No
I'm Not Sure
What do you feel needs to happen immediately to reduce and prevent youth gun violence?
Please feel free to provide any additional feedback.
THANK YOU!
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