INTERVIEW SHEET:

“SURVIVORS STORIES” CAMPAIGN INTERVIEW 2017

YOUR DETAILS (PLEASE FILL IN WHERE APPLICABLE)

FIRST NAME
LAST NAME
AGE
COUNTRY
CONTACT EMAIL

OTHER MATERIALS WE NEED TO GO WITH YOUR INTERVIEW

All completed interview sheets are to be submitted via email to , CC’d to . The deadline for submission is 10 April 2017.

When you return the completed interview sheet, please also provide us with:

a)  A picture to go with your interview

o  A recent headshot or half-body picture of yourself. This can be either a formal or informal picture.

IMPORTANT:

·  All submitted pictures should be in JPG or PNG format – large in size and in medium to high resolution - at least 600KB and approximately 600 x 1000 pixels in size or thereabouts.

·  By submitting your interview and the pictures, you are automatically giving us permission to use these materials for the “Survivors Stories” campaign. Your published interview will also be used for the purposes of our overall work to end violence against women ONLY.

b)  A 80 to 100-word bio of yourself.

o  This can be either a personal or professional bio – whatever you are comfortable with and which includes information that is safe for you to mention.

o  It should include your job/profession, your hobbies/interests, and perhaps a quick mention of your family. There should also be a brief mention of your survivor status in terms of the type of gender-based violence you faced (e.g. domestic violence, rape, sexual assault, female genital mutilation, sex trafficking etc).

o  Your bio and your answer to Question 1 are two separate things. Please see previous interviews if you are unsure about the differences: http://www.thepixelproject.net/category/survivor-stories/

Please fill in your bio in the space below here:

INTERVIEW QUESTIONS

To Note Before You Begin:

·  Please answer ALL questions on this interview sheet ONLY.

·  Your answer should NOT be bolded or italicised. This is to distinguish your answer from the question.

·  Length of each answer should ideally be between 60 - 200 words. Longer answers will be edited for length. This is because the attention span of most online readers is very short and we want to ensure that your story and solutions are as clearly, concisely and powerfully conveyed as possible to them.

·  Please return your completed interview sheet to us in Word format for editing purposes.

·  The Pixel Project reserves the right to select and edit interviews for the “Survivors Stories” campaign. Any interviews containing any form of hate and violence (in language or ideas) against any gender, sexual orientation, ethnicity, country, nationality, age group, social class etc will not be featured.

1.  What is your personal experience with gender-based violence (this may include domestic violence, rape, sexual assault, female genital mutilation etc)?

2.  How did you escape the violent situation/relationship/ritual?

3.  How did you heal and rebuild your life after the violent situation/relationship/ritual? What actions did you take?

4.  What would you suggest to or share with another woman or girl facing the same situation as you did?

5.  How do you think we can end violence against women?

6.  Why do you support The Pixel Project?