Survivor Stories

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Survivor Stories

Please share your experience in the troubled teen industry with us to further efforts to raise awareness and reform this industry.

Name *

Email *

Your contact information will not be shared.

I am a _______ *

Survivor

Parent of a Survivor

Current Employee

Past Employee

Other

If you answered "other," how would you describe yourself?

I certify that I am not a minor, and I am free and able of giving my own consent. *

Yes

Other:

Required

What year did you or someone you know attend or work at a facility? *

What facility do you have information about? *

Please share a detailed description of your experience *

If you are a Survivor or Employee, did you experience:

Sexual Abuse

Physical Abuse

Verbal Abuse

Forced Medication

Restraints

Seclusion

If you are a Survivor or Employee, did you see others experience:

Sexual Abuse

Physical Abuse

Verbal Abuse

Forced Medication

Restraints

Seclusion

Anything else you want to share with us? *

I declare under penalty of perjury that the foregoing written story I am submitting is true and correct. *

In order for us to share’ written testimonials, this legal DECLARATION OF FACT must be completed by you. This ensures your submission is truthful and factual.

I agree to the above declaration.

I disagree to the above declaration.

Other:

I hereby release this website and its owners from any and all liability, claims, demands, actions, and causes of action whatsoever arising out of or related to any loss or damage due to my submitted testimony. *

I agree to the above declaration.

I disagree to the above declaration.

Other:

Do you consent to your story being shared publicly? *

Yes, with my first name.

Anonymously.

No.

Other:

I assign rights of the submission to the website so the website can use it. *

I agree to the above declaration.

I disagree to the above declaration.

Other:

Submit

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