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* 1. Date

Date

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* 2. Gender

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* 3. County

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* 4. In dealing with the public, what best describes your role? (Choose only one)

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* 5. How much of a concern is there in your community for problems caused by alcohol, tobacco, and other drugs?

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* 6. How would you rate your knowledge of alcohol, tobacco, other drugs and mental health issues in your community?

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* 7. What resource(s) in your community would a person go to for help for a substance abuse and/or mental health problem? (Choose all that apply)

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* 8. Which substances pose the biggest problem in your community? (Select all that apply)

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