We Want Your Opinion
We are designing a campaign to challenge negative bias against aging and disability. We’d like your input in the design. If you would like help filling out this form or just want to offer input via phone, please call us at 860.314.2244 by October 16, 2023.
We are______. (Strong, Joyful, Creative, Resilient)
The campaign will have several "We are" statements accompanied by pictures. The next few questions will be about your reaction to the photos below. Please spend a few moments thinking about these photos.
Do you feel represented in these images?
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No
1
2
3
4
Yes
5
1 is No, 5 is Yes
How would you describe this group of people?
*
As you age, what words do you hope people use to describe you?
*
If you have a disability, what words do you hope people use to describe you?
What types of images would you like to see in this campaign?
*
What are your suggestions for the campaign design?
Please fill in the blanks.
*
Please fill in the blanks.
Feedback via Voice Mail
Demographic Information
We'd like to know a little about who is providing feedback. Please answer the next questions about yourself.
What is your age?
*
What is your gender?
*
Woman
Man
Other
What is your race?
*
Asian
Black/African American
Hispanic/ Latino/a/x
Native American
Pacific Islander
White
Multi-Racial
Do you have a disability?
*
Yes
No
Unsure
Are you part of any groups to challenge ageism and/or ableism?
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Yes
No
Unsure
Would you consider having your photo in the campaign?
*
Yes
No
Maybe
Name
First Name
Last Name
Email
example@example.com
Submit
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