2021 VOICES Membership Needs Assessment Survey

As we make plans for the year ahead, we are conducting this brief survey to assess the needs of our community. Your responses are confidential and will help guide the development of our support services and programs. The survey will take approximately five minutes. Please reply by Tuesday, February 9th.

Question Title

* 1. Full Name w 0

Question Title

* 2. Contact Information w 0

Preferred Email address

Phone number

Phone type: Cell, Home, Work, etc.

Question Title

* 3. Home Address
(Only complete if your address has changed.) w 0

Address

Address 2

City

State

ZIP/Postal Code

Question Title

* 4. Age w 0

18-30

31-40

41-50

51-60

61-70

71-80

81 +

Prefer not to answer

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* 5. Gender w 0

Male

Female

Prefer not to answer

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* 6. Have you or your family been directly or indirectly impacted by an act of terrorism, mass violence or another traumatic event?

w 0

I was directly or indirectly impacted by 9/11

I was directly or indirectly impacted by another tragedy

No/Not applicable

Question Title

* 7. In the last year, have you our your family been impacted directly by:
Check all that apply w 0

Loss of a loved one during the COVID-19 pandemic

Loss of a loved one due to COVID-19

Social unrest

The attack on the Capitol building

None of the above

2021 VOICES Membership Needs Assessment Survey

Question Title

* 1. Full Name w 0

Question Title

* 2. Contact Information w 0

Question Title

* 3. Home Address (Only complete if your address has changed.) w 0

Question Title

* 4. Age w 0

Question Title

* 5. Gender w 0

Question Title

* 6. Have you or your family been directly or indirectly impacted by an act of terrorism, mass violence or another traumatic event? w 0

Question Title

* 7. In the last year, have you our your family been impacted directly by:Check all that apply w 0

* 3. Home Address
(Only complete if your address has changed.) w 0

* 6. Have you or your family been directly or indirectly impacted by an act of terrorism, mass violence or another traumatic event?

w 0

* 7. In the last year, have you our your family been impacted directly by:
Check all that apply w 0