Expression of Illness survey

1

What is your age?

14-17

18-24

25-34

35-49

50-64

65+

3

What is your ethnicity?

Asian or Asian American

Black or African American

Hispanic or Latino/a/x

Middle Eastern or North African

Native American, Alaska Native, or Indigenous

Native Hawaiian or Other Pacific Islander

White or Caucasian

Prefer not to say

4

Before the film, how familiar were you with thyroid cancer?How much did you know?

Nothing at all

Somewhat

Quite a lot

A great deal

5

How much did you learn about thyroid cancer?How much did you learn?

Nothing at all

Somewhat

Quite a lot

A great deal

6

As a result of seeing Expression of Illness, I willPlease select all that apply, or select 'other' and tell us more

I'll learn more about this topic

I want to support local org working on this

I want to share this film with other people

I'm inspired to make change

Other

7

Is there a scene or conversation from the film that resonated with you? If so, how?

8

How would you or your community use this story to promote awareness?Please select all that apply or select "other" and tell us more

Host an in person screening event

Offer an online screening event of the film

A discussion or panel facilitation guide

Host a workshop tailored to my community's needs

Support connecting with local orgs

I'm not sure yet

Other

9

Would you be interested in staying connected with the film's impact campaign and host your own screening of Expression of Illness?

Yes

No

Other

10

If you want to keep in touch, write your email here!

example@example.com

11

Is there anything else you'd like to share with the film team?