Newtown Prevention Council Parent/Community Survey

Question Title

* 1. If you are a parent, what are the age ranges of your children? (check all that apply)

Pre-school

Elementary school

Intermediate school

Middle school

High school

Adult children

Question Title

* 2. Do (did) your children attend:

Public School

Private School

Home School

Question Title

* 3. Please indicate if you have concern(s) in each of the following areas. Check all that apply.

Being a single parent

Balancing work and home

Inappropriate computer/internet use

Bullying/Cyber Bullying

Communication with my child(ren)about difficult/sensitive topics

Underage drinking

Drug Use

Prescription Drug misuse

Drunk/Drugged Driving

Discipline/setting appropriate rules/boundaries/consequences

Being an effective parent(s)

Working as a team with my partner

Transitioning (to next school level)

Understanding the adolescent/preparing for the teen years

Other (please specify)

Question Title

* 4. If programs were offered in your area of concern, please indicate what type of program you would attend? (check all that apply)

A series of six to eight sessions with opportunities to practice skills

A series of two to four sessions on skill-building training

One or two sessions, mainly information based

I would not attend these programs

Question Title

* 5. When would you be most willing/able to attend programs? (check all that apply)

Morning

Afternoon

Evening

Weekdays

Weekends

Question Title

* 6. Are you aware of any community coalitions that are attempting to prevent alcohol and other drug use in Newtown? If so please list them.

Question Title

* 7. Fill in other coalition info for Question 6 here:

Question Title

* 8. Prior to this survey, had you ever heard of the Newtown Prevention Council?

Yes

No (if your answer is No, you are finished with this survey)

Question Title

* 9. In general, how much familiarity would you say you have with the Newtown Prevention Council and its activities?

None

A little

A moderate amount

A great deal

Question Title

* 10. How widespread, would you say, is the community's awareness of the Newtown Prevention Council?

None

Slight

Some

Considerable

Extensive

Question Title

* 11. Are you aware of the Newtown Prevention Council activities with:

	Yes	No
Youth and parents?	Youth and parents? Yes	Youth and parents? No
Community attitudes?	Community attitudes? Yes	Community attitudes? No
Connections between agencies?	Connections between agencies? Yes	Connections between agencies? No
Involvement of youth in planning and conducting prevention activities?	Involvement of youth in planning and conducting prevention activities? Yes	Involvement of youth in planning and conducting prevention activities? No
Policies of organization (school or community)?	Policies of organization (school or community)? Yes	Policies of organization (school or community)? No
Revisions of the health curriculum concerning alcohol and other drug problems?	Revisions of the health curriculum concerning alcohol and other drug problems? Yes	Revisions of the health curriculum concerning alcohol and other drug problems? No
Resources available for prevention of alcohol and other drug problems (such as funding or personnel)?	Resources available for prevention of alcohol and other drug problems (such as funding or personnel)? Yes	Resources available for prevention of alcohol and other drug problems (such as funding or personnel)? No

Other (please specify)

Question Title

* 12. Overall, how would you rate the progress of the Newtown Prevention Council in mobilizing your community to reduce alcohol and other substance use among youth?

No progress

Some progress

Moderate progress

Much progress

I don't know

Question Title

* 13. Overall, how would you rate the progress of the Newtown Prevention Council in implementing programming in your community that will reduce alcohol and other substance use among youth?

No progress

Some progress

Moderate progress

Much progress

I don't know

Question Title

* 14. Please enter any comments or suggestions you may have regarding the Newtown Prevention Council. For more information, please contact newtownpreventioncouncil@gmail.com
Thank you!

Question Title

* 1. If you are a parent, what are the age ranges of your children? (check all that apply)

Question Title

* 2. Do (did) your children attend:

Question Title

* 3. Please indicate if you have concern(s) in each of the following areas. Check all that apply.

Question Title

* 4. If programs were offered in your area of concern, please indicate what type of program you would attend? (check all that apply)

Question Title

* 5. When would you be most willing/able to attend programs? (check all that apply)

Question Title

* 6. Are you aware of any community coalitions that are attempting to prevent alcohol and other drug use in Newtown? If so please list them.

Question Title

* 7. Fill in other coalition info for Question 6 here:

Question Title

* 8. Prior to this survey, had you ever heard of the Newtown Prevention Council?

Question Title

* 9. In general, how much familiarity would you say you have with the Newtown Prevention Council and its activities?

Question Title

* 10. How widespread, would you say, is the community's awareness of the Newtown Prevention Council?

Question Title

* 11. Are you aware of the Newtown Prevention Council activities with:

Question Title

* 12. Overall, how would you rate the progress of the Newtown Prevention Council in mobilizing your community to reduce alcohol and other substance use among youth?

Question Title

* 13. Overall, how would you rate the progress of the Newtown Prevention Council in implementing programming in your community that will reduce alcohol and other substance use among youth?

Question Title

* 14. Please enter any comments or suggestions you may have regarding the Newtown Prevention Council. For more information, please contact newtownpreventioncouncil@gmail.com Thank you!

* 14. Please enter any comments or suggestions you may have regarding the Newtown Prevention Council. For more information, please contact newtownpreventioncouncil@gmail.com
Thank you!