The National Survivor Financial Security Policy Map and Scorecard

What policies and issues should FreeFrom prioritize?*

What policies and issues are important to you but are not included on the policy map and scorecard?*

Your state*

First Name*

Last Name*

Your pronouns (optional)

Your email (optional)

Do you identify as a survivor? (optional)

What is your gender? (select all that apply to you) (optional)

Transgender

Genderqueer / gender fluid

Gender non-conforming / non-binary

Intersex

Agender

Two-spirit

Cisgender

Woman / femme

Man / masculine

I prefer not to say

I prefer to self-describe

What is your sexuality? (select all that apply to you) (optional)

Queer

Asexual / aromantic

Bisexual

Pansexual

Lesbian

Gay

Heterosexual / straight

I prefer not to say

I prefer to self-describe

What is your race or ethnicity? (select all that apply to you) (optional)

Indigenous or American Indian or Native American or Alaska Native

Asian or Asian American

Black or African American or Haitian or other African/Black

Hispanic or Latinx

Middle Eastern or North African

Mixed race or ethnicity

Native Hawaiian or other Pacific Islander

White

I prefer not to say

We'd also like to give you the opportunity to tell us your specific race or ethnicity in an open-ended format. Please feel free to list multiple groups. (For example: Korean, Mexican American, Italian, Navajo Nation, Southerner (American), Puerto Rican, etc.).

We’re eager to learn where new policy ideas and changes come from. If you’re comfortable, please tell us more about you.

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