The following survey is part of a social art

experiment. Please answer with your first responses

for accuracy. By completing this survey you are
releasing all information that you submit for my use
in current and/or future work. Thank you for
participating.
Ashley Feagin,
LaTech Graduate Student

If you have any questions please feel free to contact me.

socialartexperiment@gmail.com
Name: (first name only)
_______________________________________________________
Age:__________________
Gender:______________________________________________________________
___________
Race:_________________________________________________________________
___________
Occupation:
___________________________________________________________________
Marital Status:
________________________________________________________________
If married, please include first name of partner; same with divorce
status, and if you are in a relationship.
Sexual
Orientation:__________________________________________________________
_
Religious
Affiliation:_________________________________________________________
Political
Affiliation:___________________________________________________________
On a scale from 1 to 10, (1 being the least, 10 the greatest) how
active were you with your party during the last presidential
election. Please include an explanation if you answer 8 or
more: _____________________________________
_______________________________________________________________________
____________
_______________________________________________________________________
____________
_______________________________________________________________________
____________
Hobbies: (list three)
1._____________________________________________________________________
____________
2._____________________________________________________________________
____________
3._____________________________________________________________________
____________
Music (list three)
1._____________________________________________________________________
____________
2._____________________________________________________________________
____________
3._____________________________________________________________________
____________
Movies (list three)
1._____________________________________________________________________
____________
2._____________________________________________________________________
____________
3._____________________________________________________________________
____________
Books (list three)
1._____________________________________________________________________
____________
2._____________________________________________________________________
____________
3._____________________________________________________________________
____________

Please check all that apply:

_____ My name can be used directly.
_____ Please use a pseudo name when referencing my
information.
_____ I would like to participate in the Blind Fold Pen
Pal Program. *
_____ I would like to be contacted for future
information about your work, mailing list, future
surveys or social art experiments.

Email address:
_____________________________________________________

Instructions for submission:

Please email this file to
socialartexperiement@gmail.com. In the subject line
please title the email: Social Art 1.

• Blind Fold Pen Pal Program (BFP3)–

Participants will be blindly corresponding with
other participants. Race, sexual preference, and
religion will be withheld when participants are
matched up. Participants will be discouraged from
discussing such topics until 2nd month of
correspondence. When discussing relationship
status , religious practices , etc use terms that are
neutral; i.e. “my significant other”, “the person I
am in a relationship with”, “ my religious
practices”, “a friend of a different nationality”, etc.
One email per participant should be sent a week.
All messages will be sent to a generic email then
forwarded to the corresponding pen pal in order to
protect all participants’ identity. Participants that
are matched up will be given a numerical code to
be identified by and used at the subject of their
emails. One can withdrawal from the BFP3 at any
time during correspondence.