Screening Questionnaire

To determine if you qualify, please answer the short survey below. Your responses will help us ensure that participants meet the criteria required for this study.

Participation is voluntary and responses are kept confidential.

Note: Adverse childhood experiences (ACEs) are potential traumatic experiences that occur in childhood when one is younger than 18 years old.

Examples include abuse, neglect, and household dysfunction.
Are you at least 19 years old?*
- Yes
- No
Are you a Black woman?*
- Yes
- No
Were you born in, and now live in, one of the Southeastern states of the U.S.?*
- Yes
- No
Before age 19, did you experience any adverse childhood experiences (ACEs) or other childhood trauma?*
- Yes
- No