Join The Sisterhood
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Share Your Story Form
Welcome to the "Share Your Story" form at the Black Women's Institute for Health. Your experiences are invaluable in shaping a better future for Black women's health. Staying silent means the stories never get told. Please break that cycle - use this form to share your story.
Demographics
What is your age range?
*
10-18 years old
19-25
26-35
36-45
46-65
65+
Postcode/Zipcode
*
What race best describes you?
*
Black
Bi-Racial
East Asian
Southeast Asian
Indigenous
Latino
Middle Eastern
South Asian
White
Other
What is your approximate annual household income?
*
Please enter data
Less than $20,000
$20,000 - $40,000
$40,000 - $60,000
Over $60,000
Prefer not to say
Share Your Story
We welcome you to share your health journey. You can choose to write your story or upload an audio/video recording.
Share Your Story
Upload a link to your audio or video recording
Your Contact Info (OPTIONAL)
First Name
Last Name
Email
*
