Cruel Money Survivor Intake Form
Your story is safe here. Protected by HIPAA-level encryption.
1. Basic Information
Thank you for trusting Cruel Money with your story. This space was created for survivors — to be heard, believed, and protected. You're in complete control of what you share. Everything you write is encrypted and kept private, protected under HIPAA-level confidentiality. Nothing will ever be shared without your written consent. If you're in crisis, please call or text 988 (U.S. Suicide & Crisis Lifeline) or visit findahelpline.com for global options.
1. Name or preferred name
You can use your real name, nickname, or an alias — whatever feels safest.
2. Pronouns
3. Email
example@example.com
4. Phone Number
Please enter a valid phone number.
5. Location (City/State)
6. Preferred way to be contacted
Please Select
Email
Phone
Facebook
TikTok
Instagram
WhatsApp
Please share your handle or username so we can contact you.
Please share your WhatsApp number so we can contact you.
7. Would you like to remain anonymous?
Please Select
Yes
No
Not sure yet
2. Your Experience
Please share what you feel comfortable telling us. There's no right or wrong way to tell your story - this is your space.
8. Name of the facility, program, or placement
9. Approximate years you were there
10. How were you placed there?
11. Please share what you experienced or witnessed.
12. Names of staff or others involved (if remembered)
13. Were there any legal actions, investigations, or news stories related to your case?
3. After the Program
Thank you for sharing what happened. This page focuses on how it's affected you and what kind of support you might want.
14. How has this experience affected you since leaving?
15. Are you currently safe and supported?
Yes
No
Prefer not to say
16. Would you be open to sharing your story in an interview — on record, off record, or anonymously?
Yes
No
Maybe later
17. How would you feel most comfortable sharing your story later, if you choose to?
Completely anonymously (voice changed or name withheld)
Using my first name only
Full name and story
Not sure yet
4. Supporting Information (Optional)
If you have anything that helps us better understand your story — photos, documents, old letters, or links — you can share them below. These uploads are encrypted and protected under HIPAA-level security.
18. Upload files
Browse Files
Drag and drop files here
Choose a file
Cancel
of
19. Add links or notes (optional)
5. Legal & Safety Considerations
Before you share anything, please take a moment to read this: We know how personal and painful these stories can be. Your safety, privacy, and peace of mind come first. If you are currently involved in a legal case or have an attorney, please avoid sharing any details that could impact your case until they’ve cleared it. If you’re unsure, you can keep things general or ask to speak privately with our producer before deciding how much to share. We take our role as journalists seriously and seek to maintain the highest levels of truth and accuracy as possible. If there are any details that you cannot fully remember, please let us know in your response. Please also know that submitting your story doesn’t automatically mean it will be featured or published. Every story we receive is handled with care and reviewed by our team to make sure it’s factual, safe, and responsibly told. After you submit, we may reach out if we need to verify details or explore the possibility of an interview. Regardless of whether your story moves forward, everything you share will remain completely confidential, encrypted, and protected under HIPAA-level privacy standards. Nothing will ever be shared or made public without your written consent. Your voice matters. Your story matters. And whether it’s shared publicly or not, what you’ve lived through will never be ignored here.
6. Final Consent
20. Please confirm you understand and agree:
I have complete control over what I share and can withdraw my story at any time.
Nothing will be used publicly without my explicit consent written consent.
All information is stored privately under HIPPA-level protection, accessible only to the Cruel Money team.
We will never sell, share, or release your information.
I retain full ownership of my story.
21. Follow-up preference
I understand and agree.
I prefer not to be contacted further at this time.
Submit
Should be Empty: