Thank you for your interest in completing in the MHSA end-of-year survey. This survey is intended to collect program participation data, participant demographic information, program activity and outcome information, and program expenditures for the last complete fiscal year (i.e., July through June).

If you are reporting on multiple programs, please complete a new survey for each program.

If you have any questions about how to complete this survey, please contact Patti Russell from Lake County Behavioral Health services at Patricia.Russell@lakecountyca.gov.

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* 1. What is your name?

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* 2. What is your contact information?

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* 3. Please select the specific MHSA program you are reporting on from the following list.
Please note: Report on one program at a time. If you would like to report on multiple programs, please complete a new survey for each one.

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* 4. Are you reporting on the first half of the current fiscal year (July - December) or the last complete fiscal year (July - June)?

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