This form is for sexual assault survivors who would like their story to be shared(or not shared) through any form of expression that they feel is appropriate be it a story, poetry, music, videos or any other form of expression. We understand that these submissions are personal and you might not be ready to share them but this might be a good outlet to have told your story on this form, and therefore your submission will not be shared unless consent is explicitly given in one of the questions in this form!

*DISCLAIMERS*
1. This form does not record your email or identify and the choice to be identified is completely voluntary!
2. As part of the Break the Chain week, if you would like for other people to hear your story, you can chose to express your own story, have one of the Value U members read your story or have your story not shared at all.
3. Please do NOT submit a story on the behalf of someone else.
4. Any information with identifying information will not be shared by anyone who isn't you.
5. If you're sharing a video, please put the url in the last section where the story goes before submission.

Please contact valueu@clarkson.edu for any questions or follow-ups.