2019 VOICES Membership Needs Assessment Survey

Voices of September 11th continues our mission to provide long-term support services and access to resources and mental health care for victims' families, survivors and responders, as well as helping communities respond to other tragedies. As we plan our programs for 2019, we want to better understand the needs of the 9/11 community by conducting a brief survey.

The survey takes approximately eight minutes to complete and your responses are confidential.

If your contact information has changed in the past year, please update it below so we can continue to keep you informed. If you have questions, contact our office at 203-966-3911. Thank you in advance for your participation!

Question Title

* Full Name

Question Title

* Home Address

Address

Address 2

City

State

ZIP/Postal Code

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* Contact Information

Phone

Phone Type (Cell, Work, Home, etc.)

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* Age

18-30

31-40

41-50

51-60

61-70

71-80

81 +

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* Gender

Male

Female

Prefer not to answer

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* Have you or your family been directly or indirectly impacted by an act of terrorism or mass violence?

I was directly or indirectly impacted by 9/11

I was directly or indirectly impacted by another act of terrorism or mass violence

No/Not applicable