Survivor Survey

Survivor Survey - About You

This Survey is Confidential and Optional
About this Survey

These questions were designed to assist us in information collection from trafficking survivors. Your answers may allow us to help you find answers you need in order to help you navigate through your survival journey. We may also use your answers to create a database of information for use in trying to discover common themes and patterns shared by survivors that may allow us to paint a full picture of how these systems work, where they have "hubs", how the financial arms operation, and how we can eventually prevent and eradicate predatory trafficking of children and adults. All information is voluntary and "I don't remember" is also a perfectly valid answer. Please select anything that applies to your experience and, remember, any answer is optional. Your individual information will not be used, given or sold to any third party. This is only for data collection and analysis purposes. You are not obligated to share anything you do not feel comfortable sharing.
What is your full name?

First and Middle NameLast Name (Use both maiden and any married names)
What is your approximate age?
Approximate Age
What was your birth gender?
Gender at Birth
Contact Number (Optional)
Format: (000) 000-0000.
Email Address (Optional)
example@example.com
If you know your City, State and Country of birth, please enter it below:

City of Birth   State of Birth
Bio Parents
Please tell us what you know about your bio parents. Choose all that apply to your situation. (Check marks will turn blue once selected)
If you know your bio MOTHER's name, date, and location of birth, please enter it here:
First Name / Middle Initial or Name / Last Name (Maiden Name Preferred)
Date of Birth
City of Birth   State of Birth
If you know your bio FATHER's name, date, and location of birth, please enter it here:
First Name / Middle Initial or Name / Last Name
Date of Birth
City of Birth   State of Birth
Please provide any information about what your BIOLOGICAL parents did for a living or what kind of industry they worked in. Please include whether either or both were in the MILITARY, and if they had a specialized skills or education, such as being a pilot, a scientist, teacher, etc.

Start Here:
ADOPTION, FOSTERING & OTHER TRANSFERS

If you were not adopted, fostered or raised by other family members, you may skip this section.
If you were ADOPTED or FOSTERED, please choose all options that apply to your situation. If you were NOT adopted, please skip this section.

Other
What was your approximate age when you were adopted or fostered?
Approximate Age
If you know the name, date, and location of birth, of the people or person who adopted or fostered you please enter it here:
First Name / Middle Initial or Name / Last Name (Maiden Name Preferred)
Date of Birth
City of Birth   State of Birth
If you know the name, date, and location of birth, of the people or person who adopted or fostered you please enter it here:
First Name / Middle Initial or Name / Last Name (Maiden Name Preferred)
Date of Birth
City of Birth   State of Birth
If you were adopted or fostered and you know the name of the agency, please enter it here:
Adoption or Foster Agency
If you were adopted or fostered through other means or methods, and you know the names of anyone who facilitated the transaction, please share that information here:
Facilitator Information
LIFE BEFORE YOU WERE TRAFFICKED

Tell us about what life was life before you were trafficked.
Many survivors report grooming, abuse and then trafficking. Please choose all options that apply to the first time you were ABUSED.

Other
How old were you when you first experienced abuse (of any kind)?
Your Approximate Age at First Abuse
How did your first abuser(s) enter your life?
Abuser's Circle of Influence
Approximately how old was the first person or persons who abused you?
Approximate Age(s) of Abuser at First Abuse
What type of work did your abuser(s) do or what job title did they have?
Abuser's Type of Work
Did your first abuser(s) ever serve in the military? If yes, do you know what job they had and which branch they were in.
Abuser's Military Service Info
If you feel comfortable doing so, you may name your abuser(s) here:
First, Middle, Last Name(s) of Abuser (s)
If there was a grooming phase, please share what that experience was to the extent you are able. We find there is often a phase where money or gifts are given to entice or coerce a child into trusting the person. Please share your experience here:
Many survivors report grooming, abuse and then trafficking. Please choose all options that apply to any manipulation or GROOMING that occurred. Some were infants or toddlers and may not remember details. That's ok. Share what you can.

Other
If you were groomed online on a social media platform or gaming platform, please share the name of which one:
Social Media or Gaming Platform of Initial Contact
If you were in a youth group or church when the abuse began, please share the name of which youth group or church here (be as specific as you like):
i.e. Boy Scouts, YMCA, Mormon Church, etc.
Did your behavior change at some point due to the abuse? If yes, please share what that looked like for you.
Yes: I began acting out......
Were there physical signs of abuse or trauma that should have been obvious to someone examining you as a child.
i.e. "Unexplained" scars, odd or recurring infections, etc.
Did you ever feel comfortable enough to tell anyone what was happening?
Sometimes survivors tell a friend or sibling.
If the abuse ended, what was it that ended it?
Aged out, we moved, etc.
At what point (how much time passed) before you went from feeling safe and trusting in that person, to feeling unsafe and betrayed by the same person?
How long between grooming and realization of abuse.
If you feel comfortable doing so, please share how long the abuse continued before you were trafficked (if you were trafficked). When did grooming and abuse start and end?
i.e. From age 5 to 12
WHO ENTERED YOU INTO TRAFFICKING?

Tell us how you became entangled in trafficking without your consent.
What was your APPROXIMATE AGE when you connected with the person(s) that trafficked you?
Approximate Age at First Connection
Approximately what YEAR was it when you connected with the person that trafficked you?
Approximate Year of First Connection (i.e. 1988)
What was your APPROXIMATE when you were placed into trafficking?
Approximate Age of First Trafficking
Approximately what YEAR was it when you were placed into trafficking?
Approximate Year of First Trafficking
If you were known by a different name than the name you were given when you were born, please enter that here:
Name Changed To / AKAs
Please choose all options that apply to the first time you were trafficked.

Other
If you chose "Other" - Tell us how you were connected with the person who placed you into trafficking?
If you know the name (real or assumed) of the person or persons who entered into trafficking, please enter that information here:
Tell us how the connections worked.

Who connected you to the "handler"? Was there a "chain of command" - meaning; was there someone above the "handler" who was in charge of how they managed trafficking you and/or others?
What types of transportation were involved when you were trafficked.

Other
If you chose "Other" - Tell us other methods of transportation that were involved?
Were you moved often, or kept in the same initial location?
If you moved around, were you always accompanied by someone? If so, who?
Do you recall other locations where you may have been transported to?
If yes, please share as much information as you can about the City, State and/or Country, your age and the year (time frame) you were transported to outside of the location where you were born and/or entered trafficking. It's ok if you don't remember.

(Example: Jan 1989, Memphis, TN, USA, hotel, I was about 13 - Handler Present: Name - Anyone else present: Name)
Check ANY states or territories you believe you were trafficked through or were abused in during a time when you were trafficked;
Check ANY other locations you believe you were trafficked through or were abused in during a time when you were trafficked;

Other
If you chose "Other" please elaborate here:
Are there any photos or documents you have that you wish to upload? Again, you are under no obligation to share anything you do not feel comfortable sharing. While we realize there may be CSAM items you have saved as evidence of your experience, please do not upload them here.

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End of Survey

It is important that you take breaks and do some self care after completing our surveys. We encourage you to write in your journal about anything that may have come up for you, or, if you have already started your blog page, you can use this time to update it now with things that have come to your memory. The next surveys will be more detailed an will begin diving deeper into the details of what went on day to day during your experience. This will be in a checklist format so you don't have to give descriptors. We want to minimize any retraumatization while we collect this important information about survivors. Thank you for sharing your story. It is so important to those who are working to move forward, heal and make real change!
By signing below, I attest that this information is true to the best of my knowledge and belief and that I give my permission for this information to be used for data collection and shared only as a part of resultant outcomes and not individually unless otherwise agreed to in writing.
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Survivor Survey - About You

About this Survey

Bio Parents

ADOPTION, FOSTERING & OTHER TRANSFERS

LIFE BEFORE YOU WERE TRAFFICKED

WHO ENTERED YOU INTO TRAFFICKING?

End of Survey