2018.10.18 Clearing the Air About Vaping – Perkiomen Valley S.D.

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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.

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* 1. Please provide the date or name of the program for which you are providing feedback:

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* 2. Gender

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* 3. Age

Under 18

18-25

26-45

46-65

66+

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* 4. How many Be a Part of the Conversation programs have you attended?

This is my first

2 to 5

5 or more

I'm not sure

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* 5. What brought you to this event? (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)

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* 6. Are you a K through 12 parent, educator, or student? (check all that apply)

	K through Grade 5	Grade 6 - 8	Grade 9 - 12
I am a K-12 parent.	I am a K-12 parent. K through Grade 5	I am a K-12 parent. Grade 6 - 8	I am a K-12 parent. Grade 9 - 12
I am a K-12 educator.	I am a K-12 educator. K through Grade 5	I am a K-12 educator. Grade 6 - 8	I am a K-12 educator. Grade 9 - 12
I am a K-12 student.	I am a K-12 student. K through Grade 5	I am a K-12 student. Grade 6 - 8	I am a K-12 student. Grade 9 - 12

If you checked any of the above, what is the name of the school or school district?

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* 7. Did you find this presentation helpful?

Very helpful

Somewhat helpful

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What did you hear that was particularly helpful?

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* 8. If you are a parent, how likely are you to initiate a conversation with your child regarding the topic presented at this event?

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Slightly

Quite

Extremely

What did you hear that will help you to have that conversation? Or, what additional information would have been helpful?

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* 9. Before attending this event, how did you feel about the topic presented?

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Knowledgeable	Knowledgeable Not at all	Knowledgeable Slightly	Knowledgeable Quite	Knowledgeable Extremely
Confident	Confident Not at all	Confident Slightly	Confident Quite	Confident Extremely
Aware of Resources	Aware of Resources Not at all	Aware of Resources Slightly	Aware of Resources Quite	Aware of Resources Extremely

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* 10. After attending this event, how do you feel about the topic presented?

	Not at all	Slightly	Quite	Extremely
Knowledgeable	Knowledgeable Not at all	Knowledgeable Slightly	Knowledgeable Quite	Knowledgeable Extremely
Confident	Confident Not at all	Confident Slightly	Confident Quite	Confident Extremely
Aware of Resources	Aware of Resources Not at all	Aware of Resources Slightly	Aware of Resources Quite	Aware of Resources Extremely

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* 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

Underage Drinking

Marijuana

Vaping / Electronic Cigarettes

Family Dynamics

Young People in Recovery from Alcoholism or Addiction

Family Members Impacted by Alcoholism or Addiction

School In-service Day or other Professional Development

"Mock Teen Bedroom" (showing indications of substance use)

Experts in the Field of Addiction

Other (please specify)

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* 12. Would you recommend a Be a Part of the Conversation program to a friend?

Yes

Maybe

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* 13. Would you attend a Be a Part of the Conversation program in the future?

Yes

Maybe

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* 14. Please share any additional feedback.

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