Event Evaluation for 2022 May Mental Health Month

Thank you for taking the time to help us improve our program. This survey is anonymous and voluntary.

Please respond to below questions based on how you feel about your experience as a direct result of this program.

At the end of the survey, you have the option to provide your contact information to enter for a chance to win a raffle prize. Please note that we report the summary (not individual) data results.

Thank you for your participation!

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* 1. How did you hear about this program?

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* 2. As a direct result of this program, I've learned MORE about mental health and/or substance use services that I can reach out to.

Strongly Agree

Agree

Neither Agree or Disagree

Disagree

Strongly Disagree

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* 3. As a direct result of this program, I am MORE willing to seek professional support for a mental health and/or substance use condition if I need it.

Strongly Agree

Agree

Neither Agree or Disagree

Disagree

Strongly Disagree

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* 4. 2022 MHM statewide theme is Take Action for Mental Health. The campaign goal is to offer our community mental wellness tools to seek help for themselves or a loved one. Please complete this sentence: "As a result of this program, I will Take Action for Mental Health by..."

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* 5. This program was relevant to me and other people of similar cultural backgrounds and experiences (race, ethnicity, gender, religion, etc).

Strongly Agree

Agree

Neither Agree or Disagree

Disagree

Strongly Disagree

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* 6. What age range are you under? (check ONE)

0-15 years

16-25 years

26-59 years

60+ years

Decline to state

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* 7. What race(s)/ethnicities(s) do you identify with? (check ALL that apply)

Asian or Asian-American

Black or African-American

Latino/a/x or Hispanic

Native American, American Indian or Indigenous

Native Hawaiian or Pacific Islander

White or Caucasian

Decline to state

If you selected, "Another race, ethnicity, or tribe", please specify.

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* 8. What is your gender identity? (check ONE)

Female/Woman/Cisgender Woman

Male/Man/Cisgender Man

Genderqueer/Gender Non-conforming/Gender Non-binary

Another gender identity (including more than one gender identity)

Decline to state

If you selected, "Another gender identity (including more than one gender identity)", please specify.

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* 9. What is your sexual orientation? (check ONE)

Lesbian

Gay

Straight or Heterosexual

Queer

Another sexual orientation

Decline to state

If you selected, "Another sexual orientation (including more than one sexual orientation)", please specify.

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* 10. What country were you born in?

United States

Outside of the United States

If you selected "Outside of the United States", please specify what country.

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* 11. What city do you live in, work or represent in San Mateo County?

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* 12. Please share any additional comments (e.g. what you liked about this program, how to improve program, types of programs are you interested in).

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* 13. [Optional] If you would like a chance win a raffle prize, please leave your email and phone number.

Please note that we report the summary (not individual) data results.

Name

Email Address

Phone Number

Thank you for taking this survey!

Question Title

* 1. How did you hear about this program?

Question Title

* 2. As a direct result of this program, I've learned MORE about mental health and/or substance use services that I can reach out to.

Question Title

* 3. As a direct result of this program, I am MORE willing to seek professional support for a mental health and/or substance use condition if I need it.

Question Title

* 4. 2022 MHM statewide theme is Take Action for Mental Health. The campaign goal is to offer our community mental wellness tools to seek help for themselves or a loved one. Please complete this sentence: "As a result of this program, I will Take Action for Mental Health by..."

Question Title

* 5. This program was relevant to me and other people of similar cultural backgrounds and experiences (race, ethnicity, gender, religion, etc).

Question Title

* 6. What age range are you under? (check ONE)

Question Title

* 7. What race(s)/ethnicities(s) do you identify with? (check ALL that apply)

Question Title

* 8. What is your gender identity? (check ONE)

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* 9. What is your sexual orientation? (check ONE)

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* 10. What country were you born in?

Question Title

* 11. What city do you live in, work or represent in San Mateo County?

Question Title

* 12. Please share any additional comments (e.g. what you liked about this program, how to improve program, types of programs are you interested in).

Question Title

* 13. [Optional] If you would like a chance win a raffle prize, please leave your email and phone number. Please note that we report the summary (not individual) data results.

* 13. [Optional] If you would like a chance win a raffle prize, please leave your email and phone number.

Please note that we report the summary (not individual) data results.