EXIT Ballroom We Care Survey Ballroom Focused Survey OK Question Title * 1. Age Under 18 18-24 25-34 35-44 45-54 55-64 65+ OK Question Title * 2. Please enter your zipcode below? OK Question Title * 3. What is your gender identity? Female Male Genderqueer or Gender Nonconforming Transgender - MtF Transgender - FtM Agender Two Spirit Not specified above, please specify OK Question Title * 4. What is your sexual orientation? Asexual Bisexual Gay Heterosexual or straight Lesbian Pansexual Queer Same Gender Loving None of the above, please specify OK Question Title * 5. Which race/ethnicity best describes you? (Please choose only one.) American Indian or Alaskan Native Afro-Latinx Asian/Pacific Islander Black/African-American Hispanic White / Caucasian Other (please specify) OK Question Title * 6. Which Scene are you affiliated with? Please select which group below Main Ballroom Scene Kiki Scene Both No affiliation OK Question Title * 7. Do you know of resources or programs in NYC for individuals struggling with crystal meth? Yes No Not sure OK Question Title * 8. How important are services for crystal meth in the Ballroom Community? Extremely important Very important Somewhat important Not so important Not at all important OK Question Title * 9. Do you know anyone in the Ballroom Community who tried crystal meth? Yes No Not sure OK Question Title * 10. Do you know anyone in the Ballroom Community who may be addicted to Crystal Meth? Yes No Not sure OK Question Title * 11. Have you ever tried Crystal Meth? Yes No OK Question Title * 12. Do you know anyone in Ballroom whose death may have been a direct, or indirect result of crystal meth use? Yes No Not sure OK Question Title * 13. Would you like to see more community-focused events that focus on addressing crystal meth use among Ballroom members? Yes No Not sure OK Question Title * 14. 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 Yes No Email Address? OK CLICK HERE WHEN DONE! FOR MORE INFORMATION, EMAIL CONTACT@BALLROOMWECARE.ORG THANK YOU!
