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Ballroom We Care Survey
Ballroom Focused Survey
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1.
Age
(Required.)
Under 18
18-24
25-34
35-44
45-54
55-64
65+
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2.
Please enter your zipcode below?
(Required.)
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3.
What is your gender identity?
(Required.)
Female
Male
Genderqueer or Gender Nonconforming
Transgender - MtF
Transgender - FtM
Agender
Two Spirit
Not specified above, please specify
4.
What is your sex assigned a birth?
Male
Female
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5.
What is your sexual orientation?
(Required.)
Asexual
Bisexual
Gay
Heterosexual or straight
Lesbian
Pansexual
Queer
Same Gender Loving
None of the above, please specify
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6.
Which race/ethnicity best describes you? (Please choose only one.)
(Required.)
American Indian or Alaskan Native
Afro-Latinx
Asian/Pacific Islander
Black/African-American
Hispanic
White / Caucasian
Other (please specify)
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7.
Which Scene are you affiliated with?
Please select which group below
(Required.)
Main Ballroom Scene
Kiki Scene
Both
No affiliation
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8.
Do you know of resources or programs in NYC for individuals struggling with crystal meth?
(Required.)
Yes
No
Not sure
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9.
How important are services for crystal meth in the Ballroom Community?
(Required.)
Extremely important
Very important
Somewhat important
Not so important
Not at all important
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10.
Do you know anyone in the Ballroom Community who tried crystal meth?
(Required.)
Yes
No
Not sure
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11.
Do you know anyone in the Ballroom Community who may be addicted to Crystal Meth?
(Required.)
Yes
No
Not sure
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12.
Have you ever tried Crystal Meth?
(Required.)
Yes
No
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13.
Do you know anyone in Ballroom whose death may have been a direct, or indirect result of crystal meth use?
(Required.)
Yes
No
Not sure
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14.
Would you like to see more community-focused events that focus on addressing crystal meth use among Ballroom members?
(Required.)
Yes
No
Not sure
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15.
Are you in need of any assistance or resources for yourself or a loved one struggling with crystal meth or mental health issues? If yes, please leave your email in the section below. All responses are anonymous
(Required.)
No
Yes
Email Address?
Current Progress,
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