Raise Your Voice, Raise Awareness Campaign
Participant Experience Survey
Section1
PERSONAL INFORMATION
Full Name
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First Name
Last Name
E-mail
*
Best Contact Number If We Have Any Questions or Wish to Feature Your Experience:
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Area Code
Phone Number
Age
*
Must be 18 or older to consent to share your experiences
Section 2
EXPERIENCE DETAILS
Please tell us a little bit about you and your family:
Please make sure you are authorized to do so if sharing experiences of family or children.
Describe your personal experiences with Racism in our communities and how they affected you and/or your family :
All experiences must meet Social Media, and Print Media Publication Standards to be published.
Please share with us, what you feel the best solution to this problem would be:
Please keep suggestions to constructive and helpful dialogue.
Imperfectly Perfect Photos & The Southern Maryland Chronicle have partnered for the Raise Your Voice, Raise Awareness Campaign. Do you give permission for your experiences, your name (first and last initial only), and your likeness (if photo is provided) to be shared both in print and online media publications? *If you answer no, your submission will be deleted from the system and not used in the campaign. If you answer yes, your experiences will be shared in our publications, and yours may be selected for a feature article, which will come with a more in depth interview with the Southern Maryland Chronicle, and professional photo provided by Imperfectly Perfect Photos.
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Please type Yes or No.
Upload an Image, Word Document or Video Experience Testimonial.
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Please make sure any uploaded files meet social media community standards
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