All submissions will be kept confidential.

FORCE will use your email address to let you know when we receive your quilt square and its final location on the national mall. If you do not submit an email address, you can locate your quilt square using your reference number. A reference number will be given to you after you submit this form.

Your Contact Information:* indicates a required field.

What keywords describe you, your quilt square, or your story? The collected keywords will be displayed in the online archive of the Monument Quilt and will help the public visualize the landscape of sexual violence in America.

Enter a comma-separated list of keywords:

ex: male survivor, acquaintance rape, ally, strong, unbreakable, family, secondary survivor, child sexual abuse, military, college.
  • I understand that FORCE is the owner of the Monument Quilt, that my quilt square and any accompanying material may be incorporated into the Monument Quilt, and that I cannot request that the quilt square be returned once it is mailed. By mailing my quilt square to FORCE, I assign to FORCE all rights to my submitted quilt square.
  • FORCE may contact me if they need additional information.
  • FORCE may contact me if the media is interested in my quilt square.