We would love to hear from you!
Your feedback is incredibly valuable so that we may provide the best possible experience for future Be a Part of the Conversation online programs. The survey should take
less than five minutes
to complete. Thank you in advance for completing this survey!
Your responses are completely anonymous.
By participating in this survey you understand and agree that some overall results and some open-ended remarks may be shared for administrative or marketing purposes.
Our Mission
Be a Part of the Conversation addresses substance use, misuse and addiction and its impact on individuals and their families by building a culture of awareness and support.
1.
Please provide the
date
or
name
of the online program for which you are providing feedback:
2.
What is your gender? You can choose multiple options.
Female
Male
Nonbinary or Genderqueer
Decline to State
Different Identity
3.
Which race/ethnicity best describes you? (Please choose only one.)
American Indian or Alaskan Native
Asian / Pacific Islander
Black or African American
Hispanic
White / Caucasian
Prefer not to say
Multiple ethnicity / Other (please specify)
4.
Age
Under 18
18-25
26-45
46-65
66+
5.
How many
Be a Part of the Conversation
programs (whether in-person or online) have you attended?
This is my first
2 to 5
5 or more
I'm not sure
6.
What brought you to this program? (check all that apply)
General Interest
I want to learn about the prevention of substance use and/or addiction.
Professional Interest (Medical/Health Care)
Professional Interest (Treatment/Therapeutic)
I am concerned about someone who is struggling with substance use.
I know someone who is currently in recovery from a substance use disorder/addiction.
I am currently struggling with substance use.
I am currently in recovery from a substance use disorder/addiction.
Other (please specify)
7.
Did you find this presentation helpful?
Very helpful
Somewhat helpful
Not very helpful
8.
What did you hear at this program that was particularly helpful?
9.
Before
this program, how did you feel about the topic presented?
Not at all
Slightly
Quite
Extremely
Knowledgeable
Not at all
Slightly
Quite
Extremely
Aware of Resources
Not at all
Slightly
Quite
Extremely
10.
After
this program, how do you feel about the topic presented?
Not at all
Slightly
Quite
Extremely
Knowledgeable
Not at all
Slightly
Quite
Extremely
Aware of Resources
Not at all
Slightly
Quite
Extremely
11.
Which of the following topics would you like us to present in the future? (check as many as you like)
Setting Healthy Boundaries
Technology & Youth
Isolation in the time of COVID-19
Underage Drinking
Addiction 101
Marijuana
Vaping / Electronic Cigarettes
Prescription Drug Misuse / Addiction
Pathways to Recovery
Experts in the Field of Addiction
Other (please specify)
12.
Would you recommend a Be a Part of the Conversation program to a friend?
Yes
Maybe
No
13.
Would you participate in a Be a Part of the Conversation program in the future?
Yes
Maybe
No
14.
Please share any additional feedback.
Be a Part of the Conversation is a 501(c)3 nonprofit organization.
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If you are interested in volunteering, please send an email to
info@conversation.zone
Visit our website to learn more:
www.conversation.zone
Thank you, and take good care of yourself!
We sincerely appreciate your feedback.