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Feedback Form
Tell us what you think of the About-Face website! We love hearing from you.
Note that our feedback form contains some demographic questions, because information about the people we reach helps when we ask for funding (and funding helps us change the world). All questions are optional, of course.
And be sure to sign up for our mailing list, so you'll hear about upcoming events and website changes. The information you provide will be used only by About-Face - we would never, ever give it away or sell it to anyone.
Thank you!

Please Describe Yourself

First Name:

Last Name:

e-mail:

Street Address:

City:

State/Province:

ZIP/Postal Code:

Country:

Telephone:

Age:

Gender: Female Male Transgender

Occupation:

What is your racial or ethnic background?:
(Check all or any that apply)

African American Latina/Latino

Asian/Pacific Islander Native American/Alaskan Native

Caucasian/European American Arab/Middle-Eastern

Other
Please specify:

What is the highest level of education you've completed?

What is the total income of your household?

Would you describe your residential area as:

Would you like to be on our mailing list?
(NOTE: You must supply your address if you would like to be on the mailing list.) Yes      No

Website Evaluation

Please complete the following evaluation. Your feedback is very important to us and helps us improve our website and overall organization.
Was the About-Face website effective in meeting the goals described below?
(1 = Strongly Disagree; 5 = Strongly Agree).

GENERAL AWARENESS

After viewing this website:
a. I am more able to question the images I see in the media.

1 2 3 4 5

b. My knowledge of eating disorders has increased.

1 2 3 4 5

c. I am more aware of how the media can influence thoughts and feelings.

1 2 3 4 5

PERSONAL EMPOWERMENT

After viewing this website:
a. I am more able to give myself positive messages about my body.

1 2 3 4 5

b. I have an increased appreciation for my own body.

1 2 3 4 5

c. I feel better about how my body looks.

1 2 3 4 5

ACTION

After viewing this website:
a. I have an increased understanding of how I may help others have a more positive body image.

1 2 3 4 5

b. I intend to stop negative comments about body shapes, both from myself and others.

1 2 3 4 5

c. I intend to think about a company's advertising practices when making purchase decisions.

1 2 3 4 5

d. I support About-Face's efforts and believe this topic is of great importance.

1 2 3 4 5

GENERAL QUESTIONS:

Before viewing this website, I was unaware that there were organized community outreach efforts to address women's body image needs. Yes      No

If I'd had the benefit of the information on this website while I was growing up it would have positively impacted my body image. Yes      No

I am interested in the materials on this website because of:

Personal experiences Experience of a loved one Both

Do you have any suggestions on how we could improve this website?

How did you find us?:

Other:

How often do you visit the About-Face website?

Would you come back to the About-Face website?: Yes      No

If not, why?

Would you tell a friend about this site? Yes      No

Any Other Comments:

May we reprint your feedback on the site? Yes      No

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