Online Survey Software | Qualtrics Survey Solutions

Thank you for signing up to participate in One Small Step with UVA's Karsh Institute of Democracy! One Small Step is an opportunity to bridge divides by recording a meaningful conversation with a fellow community member who has a different perspective than you.
The following form asks some questions about you that will help us match you a great interview partner.
(Est. time to complete form: 3-5 minutes)

What is your name?

First Name

Last Name

City

State

Zip Code

Email Address

Preferred Phone Number