Community Profile

Welcome to our Community Profile Survey

Please take a few minutes to complete all questions as your opinion matters.

Please know that your personal information is for demographic analysis only and will not be shared with any third party or posted on the Internet.

We need your feedback to present statistics to the public, elected officials, and the media, that reveals the effects of the inhumane targeting of citizens througout this nation and the globe.

After completing this survey, you will be redirected to the Survey Methods website.

Thank you,
FFCHS Staff

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1.	Please enter your contact information

First Name
Last Name
Address
Address
City
US State
Zip Code
Home Phone
Cell Phone
Email Address

2.	Country or Region of the World

3.	Year of Birth

Gender

5.	Marital Status

	Single - never married
	Single - divorced
	Separated
	Married

6.	What is your race or ethnic background? The answer to this question may be important in determining target selection.

	African
	Caucasian
	Asian
If other, please specify

7.	What is your religious affiliation?

8.	Highest Education Level

9.	Are you employed?

Yes No

10.	If yes, what type of job do you have?

11.	Do you have a website?

Yes No

12.	If so, what's the url? Or leave blank.

13.	Do you have a blog?

Yes No

14.	If so, what's the url? Or leave blank.

15.	Where did your targeting start?

16.	When did your targeting start?

17.	If outside the US, in what country or region did your targeting begin?

18.	Who do you believe is targeting you? You may select one or more responses

	NSA
	CIA
	FBI
	Secret Service
	A Military Intelligence Agency
	Not Sure
If other, please specify

19.	Are you an organized stalking victim?

Yes No

20.	Are you a Directed Energy Weapons victim?

Yes No

21.	Has your physician been of any support or assistance to you in treating your medical condition(s) due to the directed energy assaults?

	Yes
	No
	N/A

22.	Have you reported your harassment to your local police?

Yes No

23.	If yes, what was their response? You may select one or more responses.

	Interested, will look into the matter
	Listened, but took no further action
	Referred to other department or agency
	Uninterested, no action taken
	Recommended psychiatric evaluation
	Hostile

24.	Have you reported your harassment to the FBI?

Yes No

25.	If yes, what was their response? You may select one or more responses.

	Interested, will look into the matter
	Listened, but took no further action
	Referred to other department or agency
	Uninterested, no action taken
	Recommended psychiatric evaluation
	Hostile

26.	Have you sought assistance regarding your harassment from your state or congressional officials?

Yes No

27.	If yes, what was their response? You may select one or more responses.

	Interested, will look into the matter
	Listened, but took no further action
	Referred to other department or agency
	Uninterested, no action taken
	Recommended psychiatric evaluation
	Hostile

28.	When your targeting began, did you live near a military base?

Yes No

29.	When your targeting began, did you live near a defense contractor(s)?

Yes No Not Sure

30.	When your targeting began, did you live near a weapons manufacturer(s)?

Yes No Not Sure

31.	When your targeting began, did you live near a US intelligence agency?

Yes No Not Sure

32.	When your targeting began, did you live near a major university(ies)?

Yes No

33.	When your targeting began, did you live near a major hospital?

Yes No

34.	When your targeting began, did you live near a biomedical research facility?

Yes No Not Sure

35.	When your targeting began, did you live near a public or private psychiatric facility?

Yes No Not Sure