FACSAFOUNDATION.ORG SHATTERING THE SILENCE TOUR DOCUMENTARY PROJECT Volume 2 January 2015 | Page 80

We are beginning the research part of our project and would love for you to
be a part of that. Please fill out the questionnaire here or on our website at
FACSAFoundation.org. Thank you very much. This will enable us to better
serve our communities and provide safer environments for children.
Survivor’s Personal Preference Questionnaire

This personal preference questionnaire is designed to measure a survivor’s
communication skills, personal preferences, and anger management skills. Please
take your time and answer all questions.
Your personal preference is measured on a performance scale. Please fill in the
blank or Circle the Answer which best represents you and your experience.

Disclaimer: If you are prone to triggers, please seek your regular counselor, pastor,
or call 1-800-therapist, or http://www.therapycounseling.com/ for a free
consultation.
All stories posted below should be done under a fake name and by sharing your
story, you are giving the FACSA Foundation (Family and Friends Fighting Against
Child Sexual Assault) permission to use your story and information, for prevention
and education of child sexual assault through books, tapes, cd’s, dvd’s, seminars,
webinars, and other education/prevention and public relations purposes.

1) Gender: Male or Female ──────

3) Number of siblings you have now?
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2) Age? ──────