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RIGHTFOOTED™
The documentary
of Jessica Cox
Support this film!
International Keynote Speaker
Think Outside the Shoe™
Survey
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Survey
Please help Jessica by filling out this survey.
Name
*
First
Last
Email
*
Organization/School
* If you have attended a live event
How did you first hear about Jessica Cox?
Word of mouth
Email/Powerpoint
YouTube
Facebook
TV / radio
Live presentation
What are the MOST inspiring things Jessica has done? * Please pick 3 or less.
Feeding and dressing herself
Writing
Driving a car
Swimming
Surfing
Scuba Diving
Flying a plane
Getting married
Her faith
How inspiring are Jessica's videos that you have seen?
(1 is not very inspiring, 5 is highly inspiring)
5
4
3
2
1
I haven't seen any of Jessica's videos
Why do you feel that way about Jessica's videos? What emotions do they evoke in you?
*optional
Do you follow Jessica on any of these social media sites?
Facebook
Twitter
Google+
LinkedIn
YouTube
None
How would you rate Jessica's live presentation?
*1 being lowest, 5 being high
5
4
3
2
1
I haven't seen a live presentation
What specifically did you gain from Jessica's presentation?
Select the stories you remember actually hearing during a live presentation?
Her parent's reaction when she was born.
Her first dance performance.
Learning to tie her shoelaces.
Deciding not to use prosthetic arms.
Getting her driver's license.
Fueling up her car.
Moving a TV.
The struggles during flight training.
Figuring out how to buckle the seat belt in her airplane.
Meeting her future husband.
Meeting Luisa, an armless teacher in Ghana.
What story has stuck with you the most?
Either live, through a video or any other means.
What quote has stuck with you the most?
Either live, through a video or any other means.
What do you want to see or hear more of in Jessica's live presentation?
How would you describe Jessica and her message?
May Jessica use your answers for promotionas and on her website?
*We will contact you via email if Jessica decides to use your quote.
Yes
No
The sum of 0 and 4 is:
*
To prove that you are a human :)