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National Talk Show Looking for Male Survivors

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A national talk show is looking for male survivors of childhood sexual assault and molestation to be audience members. This show aims to increase awareness about male survivors of sexual abuse.

If you are interested in potentially being an audience member, please fill out and submit this form to the best of your ability.

Thank you for your time and your willingness to help others understand and recover from sexual abuse.










Relationship to Perpetrator:

Age at Time of Abuse:

Nature of Abuse:

Was the Abuse Reported to Police?:


Was the Perpetrator Prosecuted?:


Was There a Conviction?:


Was the Abuse Ongoing?:


Thank you for your time and your willingness to help others understand and recover from sexual abuse.


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