The purpose of this survey is to evaluate the effectiveness of Churchill Community Coalition.

The Churchill Community Coalition strives to reach all community members through community-wide partnerships and assessments to address community needs.  Topics include:
                                                                                  Ÿ Health and Wellness
                                                                           Ÿ Mental and Behavioral Health
                                                     Ÿ Substance Misuse / Abuse Awareness and Prevention
                                                                   This survey is voluntary and anonymous.

 PLEASE answer question numbers 1-22 and the last two for all participants and each category specific group of questions that you associate with. Many of you will identify with more than one category. These category specific options are asked about in question number four. Thank you graciously for your time in taking this survey. This information is valuable in our efforts to serve you better.

* 1. Gender

* 4. Are you in any of the following categories? Please check ALL that apply and answer the category specific questions that follow in this survey. Thank you.

* 5. Are you aware of the Churchill Community Coalition and the work it does in the community?

* 6. Have you used any of the Coalition’s services? 

* 7. Are you aware of Churchill Community Coalition’s website?

* 8. Are you aware of the Churchill County Board of Health?

* 9. Are you aware of the Churchill County Behavioral Health Task Force?

* 10. On issues related to substance abuse, what are some of the issues you see or have concerns about within the community? Please explain:

* 11. On issues related to health & wellness, what are some of the issues you recognize and/or have concerns about in the community? Please explain:

* 12. On issues related to mental health and wellness, what are some of the issues you think need to be addressed in our community? Please explain:

* 13. Please tell us about the local resources you are aware of and how to access them:

* 14. Are you aware the Coalition works on issues of advocacy, policy, and law as well as prevention and awareness education?

* 15. Do you believe you have a voice in your community?

* 16. How can the Coalition help you and/or your business have a safe, smoke and drug free environment/workforce? Please Explain:

* 17. Areas in the community that I perceive need improvement. Check all that apply:

* 18. Do you believe that the health services in our community need improvement? 

* 19. Do you believe that the mental health services in our community need improvement? 

* 20. Do you believe that the behavioral health services in our community need improvement? 

* 21. Do you think Churchill County has a homeless problem?

* 22. Please rank in order of your priority.

* 23. If you are 60 years or older, please answer questions 23-27.                                                                             #23) Please tell us what type of information or support you would like to see for older adults in our community.

* 24. How is the Coalition serving the older adults in the community? Please explain.

* 25. Do you want to retire in this community?

* 26. Do you feel that the older adults’ collective concerns/voice is heard in the community? Please explain.

* 27. What are the best ways for you to receive information on current community issues? Please explain:

* 28. If you are a parent, please answer questions 28-38.                                                                                                     #28) What are your current community concerns? Please explain:

* 29. Are your community concerns being addressed?

* 30. Is the Coalition active in addressing your community concern?

* 31. Which community organizations are most effective in addressing your concerns?

* 32. Which community organizations would you like to see more involved in your community to address your concerns? Please explain:

* 33. Do you feel safe in your community?

* 34. Are your needs being addressed in the community?

* 35. Are you aware of the services the Coalition provides?

* 36. What is the best way for the Coalition to communicate on important topics and events?

* 37. The Coalition is interested in getting feedback from parents in the community. What would be the best way for you to contact us?

* 38. What are our community strengths? Please explain.

* 39. If you are serving in or affiliated with the military, please answer questions 39-41.                                #39) What type of materials/marketing would you like to receive on the services and programs the Coalition supports and how often? Weekly, Monthly, Bi-annually, Annually, or for Events

* 40. Are you interested in learning more about the services and programs the Coalition supports in the local community?

* 41. How could the military voice their concerns on community issues? Please explain:

* 42. If you serve in law enforcement please answer questions 42-45.                                                                          #42) What is the Coalition doing to support law enforcement?

* 43. Is law enforcement able to find out what the current issues are in our community?

* 44. How can our community help law enforcement?

* 45. What additional Coalition resources, partnerships, and/or collaborations would assist law enforcement? Please explain.

* 46. If you own a business please answer questions 46-49.                                                                                             #46) Do you have a voice as a business in the community?

* 47. Are you able to find out what the current issues are in the community?

* 48. What do you feel impacts hiring, employment, safety, and employees in our community?

* 49. Are these issues keeping new businesses out of the community?

* 50. If you are in the field of education, please answer questions 50-55.                                                                   #50) What is the Coalition doing to support educational institutions?

* 51. Is there an active partnership with the Coalition and the School District?

* 52. Do you have concerns about any of the following for kids in the community today?

* 53. Are any of the above issues a problem in your classroom?

* 54. As an educator, do you have a voice in our community? 

* 55. Are you able to find out what the current issues are in the community?

* 56. If you are of a faith based organization, please answer questions 56-59.                                                          #56) What is the Coalition doing to support faith based organizations?

* 57. As a faith based institution, do you feel you have a voice in the community?

* 58. Are you able to find out what the current issues are in the community? 

* 59. What further resources, partnerships, and/or collaborations would assist your faith-based organization: Please explain:

* 60. If you are in the medical, mental or behavioral healthcare professions, please answer                          questions 60-65.                                                                                                                                                          #60)That/Those healthcare profession(s) is/are:

* 61. What is the Coalition doing to support your profession?

* 62. What issues prevent practitioners from relocating to Churchill County? Please explain.

* 63. How could medical/mental/behavioral healthcare providers have a better voice in our community? Please explain

* 64. What current community issues do you have concerns about? Please explain.

* 65. How is the Coalition partnering with your professional community?

* 66. Are you interested in finding out more about the mission, works and resources of Churchill Community Coalition and ways to help and/or support in its efforts? Please share.

* 67. Please provide your name and a preferred way of contact if you would like to be contacted regarding the above question.

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