Arts and Health Network Canada
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1. Arts and Health Network Canada Survey

1. Please indicate how likely you are to personally use the Arts Health Network Canada (AHNC) web site for the following purposes, where 1= very unlikely to use; 2 = somewhat unlikely to use; 3 = somewhat likely to use; 4 = very likely to use.

Other (please describe)

2. What are your top three priorities for AHNC to focus on in its first 18 months? Please describe.

What are your top three priorities for AHNC to focus on in its first 18 months? Please describe.

3. Please tell us a little about yourself

Please tell us a little about yourself Country of residence
Canadian province of residence

4. Do you consider yourself an arts and health practitioner?

Do you consider yourself an arts and health practitioner? Yes	No
If yes, please describe your discipline(s) and / or focus of practice

5. I am (please check all that apply):

	Yes	No
A user of arts and health programs / services	*I am (please check all that apply): A user of arts and health programs / services Yes	A user of arts and health programs / services No
Artist (hobby, amateur or professional)	Artist (hobby, amateur or professional) Yes	Artist (hobby, amateur or professional) No
Health professional/worker	Health professional/worker Yes	Health professional/worker No
Creative Arts Therapist	Creative Arts Therapist Yes	Creative Arts Therapist No
University or college instructor/researcher	University or college instructor/researcher Yes	University or college instructor/researcher No
Elementary/secondary educator	Elementary/secondary educator Yes	Elementary/secondary educator No
Manager/administrator/decision-maker	Manager/administrator/decision-maker Yes	Manager/administrator/decision-maker No
Elected official	Elected official Yes	Elected official No

Other (please specify)

6. Are you:

Are you: Male

Female

7. THANK YOU FOR RESPONDING TO THE SURVEY!
If you would like to receive periodic emails on developments in arts and health in Canada, please type your name and email address below. You can ask to have your email removed from the distribution list at any time. Your email will ONLY be used to send you arts and health updates and news. It will NOT be shared with any other organization.

THANK YOU FOR RESPONDING TO THE SURVEY! If you would like to receive periodic emails on developments in arts and health in Canada, please type your name and email address below. You can ask to have your email removed from the distribution list at any time. Your email will ONLY be used to send you arts and health updates and news. It will NOT be shared with any other organization. Name
Email

You are cordially invited to send us information on your organization / programs / events / areas of practice / and publications for inclusion in the “What’s New”, “Events & Workshops”, “Directory of Organizations and Practitioners”, and” Resources” sections of the website. These sections will now be updated monthly. Please include whatever contact information you wish others to use to contact you (email, web site address – no phone numbers please).

Send your information to Arts and Health Network Canada

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Learn about arts and health programs, activities and events across Canada	*Please indicate how likely you are to personally use the Arts Health Network Canada (AHNC) web site for the following purposes, where 1= very unlikely to use; 2 = somewhat unlikely to use; 3 = somewhat likely to use; 4 = very likely to use. Learn about arts and health programs, activities and events across Canada 1	Learn about arts and health programs, activities and events across Canada 2	Learn about arts and health programs, activities and events across Canada 3	Learn about arts and health programs, activities and events across Canada 4
Learn about arts and health programs, activities and events in my own province	Learn about arts and health programs, activities and events in my own province 1	Learn about arts and health programs, activities and events in my own province 2	Learn about arts and health programs, activities and events in my own province 3	Learn about arts and health programs, activities and events in my own province 4
Learn about arts and health programs, activities and events in other countries	Learn about arts and health programs, activities and events in other countries 1	Learn about arts and health programs, activities and events in other countries 2	Learn about arts and health programs, activities and events in other countries 3	Learn about arts and health programs, activities and events in other countries 4
Connect and share with like-minded professionals, others doing similar work	Connect and share with like-minded professionals, others doing similar work 1	Connect and share with like-minded professionals, others doing similar work 2	Connect and share with like-minded professionals, others doing similar work 3	Connect and share with like-minded professionals, others doing similar work 4
Locate practitioners for personal use or referrals	Locate practitioners for personal use or referrals 1	Locate practitioners for personal use or referrals 2	Locate practitioners for personal use or referrals 3	Locate practitioners for personal use or referrals 4
Post information, studies, articles, photos, or videos about my own work / programs	Post information, studies, articles, photos, or videos about my own work / programs 1	Post information, studies, articles, photos, or videos about my own work / programs 2	Post information, studies, articles, photos, or videos about my own work / programs 3	Post information, studies, articles, photos, or videos about my own work / programs 4
Seek feedback or support from others; share ideas and experiences	Seek feedback or support from others; share ideas and experiences 1	Seek feedback or support from others; share ideas and experiences 2	Seek feedback or support from others; share ideas and experiences 3	Seek feedback or support from others; share ideas and experiences 4
Find potential research collaborators	Find potential research collaborators 1	Find potential research collaborators 2	Find potential research collaborators 3	Find potential research collaborators 4
Find researchers interested in evaluating or documenting my own work / programs	Find researchers interested in evaluating or documenting my own work / programs 1	Find researchers interested in evaluating or documenting my own work / programs 2	Find researchers interested in evaluating or documenting my own work / programs 3	Find researchers interested in evaluating or documenting my own work / programs 4
Find artists / organizations who want research or evaluations of some aspect of their programs / work	Find artists / organizations who want research or evaluations of some aspect of their programs / work 1	Find artists / organizations who want research or evaluations of some aspect of their programs / work 2	Find artists / organizations who want research or evaluations of some aspect of their programs / work 3	Find artists / organizations who want research or evaluations of some aspect of their programs / work 4
Stay current on research and publications on arts and health in Canada	Stay current on research and publications on arts and health in Canada 1	Stay current on research and publications on arts and health in Canada 2	Stay current on research and publications on arts and health in Canada 3	Stay current on research and publications on arts and health in Canada 4
Stay current on research and publications on arts and health in other countries	Stay current on research and publications on arts and health in other countries 1	Stay current on research and publications on arts and health in other countries 2	Stay current on research and publications on arts and health in other countries 3	Stay current on research and publications on arts and health in other countries 4
Find information on research methodologies for arts and health evaluations, arts-informed research or arts dissemination of research results	Find information on research methodologies for arts and health evaluations, arts-informed research or arts dissemination of research results 1	Find information on research methodologies for arts and health evaluations, arts-informed research or arts dissemination of research results 2	Find information on research methodologies for arts and health evaluations, arts-informed research or arts dissemination of research results 3	Find information on research methodologies for arts and health evaluations, arts-informed research or arts dissemination of research results 4
Learn about best practices in Canada and elsewhere	Learn about best practices in Canada and elsewhere 1	Learn about best practices in Canada and elsewhere 2	Learn about best practices in Canada and elsewhere 3	Learn about best practices in Canada and elsewhere 4
Find training and education opportunities in Canada	Find training and education opportunities in Canada 1	Find training and education opportunities in Canada 2	Find training and education opportunities in Canada 3	Find training and education opportunities in Canada 4
Locate information on possible funding sources	Locate information on possible funding sources 1	Locate information on possible funding sources 2	Locate information on possible funding sources 3	Locate information on possible funding sources 4
Access materials on arts and health to use in presentations, funding applications, etc.	Access materials on arts and health to use in presentations, funding applications, etc. 1	Access materials on arts and health to use in presentations, funding applications, etc. 2	Access materials on arts and health to use in presentations, funding applications, etc. 3	Access materials on arts and health to use in presentations, funding applications, etc. 4
Refer others for basic information on arts and health and “validation” of its worth	Refer others for basic information on arts and health and “validation” of its worth 1	Refer others for basic information on arts and health and “validation” of its worth 2	Refer others for basic information on arts and health and “validation” of its worth 3	Refer others for basic information on arts and health and “validation” of its worth 4
Connect with possible mentors for arts and health programs	Connect with possible mentors for arts and health programs 1	Connect with possible mentors for arts and health programs 2	Connect with possible mentors for arts and health programs 3	Connect with possible mentors for arts and health programs 4
Post or find information about employment opportunities in arts and health	Post or find information about employment opportunities in arts and health 1	Post or find information about employment opportunities in arts and health 2	Post or find information about employment opportunities in arts and health 3	Post or find information about employment opportunities in arts and health 4
To engage in dialogue on-line or blogging on any of the above or other arts related topics	To engage in dialogue on-line or blogging on any of the above or other arts related topics 1	To engage in dialogue on-line or blogging on any of the above or other arts related topics 2	To engage in dialogue on-line or blogging on any of the above or other arts related topics 3	To engage in dialogue on-line or blogging on any of the above or other arts related topics 4

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