Source-tracking survey

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

This form should be filled out by reporters (you'll fill out the form once for each source). The top section of this form, intended to be filled out by reporters, includes the questions that should be asked of sources (either during a call, with the reporter filling in answers as they go, or via email, using a template provided to the source by the reporter). The second section of this form includes questions about the story slug/headline, category, date of story publication, etc. Note that for privacy reasons we do not collect sources' names.

Blurb to use with sources

Thank you for making the time for an interview with [publication]. We are committed to including diverse sources in our stories so that we can accurately capture the range of people whose voices, perspectives, and expertise are relevant. Toward that end, we try to track information about who our sources are. If you are comfortable doing so, we would appreciate it if you would provide us with some information about the communities you are part of. This information will be stored securely and will be used only for internal accountability purposes. No individual information that you did not also share as part of an interview will be shared publicly. Again, this is voluntary, but would be helpful to us as we work toward greater equity and inclusion in our coverage. (If you have previously been interviewed for a story at [publication], you may have been asked to provide this information before. We would appreciate it if you would do so again, as we collect demographic information separately for each story, and because some aspects of people’s identities may shift over time.)

1. What country do you live in most or all of the time? *

2. How would you best describe your race/ethnicity? Select all that apply. (Note: Please consider the "Other" field as "Other or Prefer to Self-Describe) *

American Indian or Alaska Native

Asian

Black or African American

Hispanic, Latino, or Spanish Origin

Middle Eastern or North African

Native Hawaiian or Other Pacific Islander

Other Indigenous/Aboriginal

White

Prefer not to disclose

Other:

Required

3. How would you best describe your current gender identity? Select all that apply. (Note: Please consider the "Other" field as "Other or Prefer to Self-Describe) *

Man

Woman

Non-Binary or Genderqueer

Unsure or Questioning

Prefer not to disclose

Other:

Required

4. Are you a member of the LGBTQ+ community? *

Yes

Prefer not to disclose

Other:

5. Do you identify as a person with a disability, or as a person with accessibility needs? *

Yes

Prefer not to disclose

Other:

6. Is there anything you would like to clarify or elaborate upon with respect to your responses above, or that you'd like to add about the communities to which you belong?

Clear form

Never submit passwords through Google Forms.

This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy

Forms