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EmpowHER Interest Form

What is your preferred name?

*

How do you currently get your period products?

*

How do you currently get your period products?

A

I buy them at the store each month

B

My parent/guardian buys them

C

I stock up ahead of time

D

I use whatever is available at home

E

Other (write below):

Would you rather choose every item yourself or get a surprise each month with some flexibility?

*

Would you rather choose every item yourself or get a surprise each month with some flexibility?

A

Customize the whole box

B

A mix of custom + surprise

C

Surprise me!

What do you find most annoying or stressful about managing your period each month?

*

What would make this box really special to you?

*

How often would you want boxes delivered to you?

*

How often would you want boxes delivered to you?

A

Monthly

B

Bi-Monthly

C

Every 3 months

D

Every 6 months

Would you be interested in helping us support people facing period poverty?

*

Would you be interested in helping us support people facing period poverty?

A

Yes!

B

Maybe, I need to know more

C

No Thanks

How would you prefer we give back?

Donating period products

Donating boxes to schools/shelters

Partnering with local nonprofits

Other (write below):

How did you find out about EmpowHER?

*

How did you find out about EmpowHER?

A

From a friend

B

Social media

C

Search engine

D

Other (write below):

To stay in the loop, join our email list:

*