Family Peer Network Community Leadership Survey

Families Together in New York State gathers ideas and feedback from our statewide network of families, young people, and system partners to help guide our advocacy and strengthen the family voice. The information you provide will help us learn more about how you carry the family voice in your area and how you connect with your community. We will use the information you provide to better support your efforts and facilitate deeper connections among our network. Please provide us as much details as possible. We may reach out to you in the future to learn more about your experiences and partner with you and other families across the state doing similar work.

If you have any questions, please contact Brad Hansen, Public Policy Coordinator at bhansen@ftnys.org or 518.432.0333 x 28.

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* 1. Would you like us to connect you with families involved in similar work across the state? If yes, please provide your contact information:

Name

Address

ZIP/Postal Code

Email Address

Phone Number

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* 2. Select the county you live in.

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* 3. I work as a:

Family Peer Advocate

Youth Peer Advocate

Other (please specify)

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* 4. I am the parent/caregiver of a young person... (check all that apply):

involved with mental health services

involved in foster care, kinship and/or family court

involved with substance abuse services

involved with the juvenile justice system

with a developmental disability

on the Autism Spectrum

involved with vocational/employment challenges

in foster care (foster family)

in foster care (birth parent)

as a non-parent or kinship caregiver (outside of formal foster care)

Please describe any details you wish to share about the experiences you selected above.

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* 5. I am a young person... (check all that apply):

involved with mental health services

involved in foster care, kinship and/or family court

involved with substance abuse services

involved with the juvenile justice system

with a developmental disability

on the Autism Spectrum

involved with vocational/employment challenges

who lived with a non-parent or kinship caregiver

Please describe any details you wish to share about the experiences you selected above.

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* 6. Do you actively participate in any committees, support groups, advisory councils, task forces, lobby days, boards, or workgroups? This is not limited to being related to children's services.

Yes, I participate.

No, I don't.

I would like to.

Please share the group's name, it's purpose, the role you play, and any other details you think are important.

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* 7. Are you involved in civic, voluntary, or community groups? This includes cultural groups, faith traditions, social clubs, support groups, advocacy groups, mentor services, community service, recreational programs, chambers of commerce, unions, or political organizations.

Yes, I am

No, I am not.

I would like to be.

Please share the group's name(s), what they are about, and any other details you think are important.

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* 8. Are you a registered voter?

Yes, and I vote.

Yes, but I don't vote.

I'm not sure.

No, but I would like to register.

No.

Tell us more about involvement in politics and government.

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* 9. Families Together believes the family voice is absolutely necessary for effective policy-making. Please identify policy efforts you may be interested in participating in:

Forums

Press Conferences

Focus Groups

Legislator Visits

Opinion Editorials

Planning Committees

Letter-writing and Phone Calls

Surveys Distribution and Interviews

Candidate Questionnaires

Community Events

Voter Registration

All of the above

Do you currently participate in any of these activites ? Tell us more!

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* 10. Would like to join our e-news lists?

FTNYS News

YOUTH POWER!