Event and Programming Questionnaire

The purpose of this survey is for the Maine Resiliency Center to learn more about what services you would like to see here. This survey should take no longer than 15 minutes and will be helpful for the MRC in continuing to develop events and programs both at the center and outside of it. Thank you for taking the time to provide us with your feedback. It is greatly appreciated!

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* 1. What is your contact information? This information is assist in follow up and identifying geographical areas of those impacted.

Name

Age

City/Town

State/Province

Email Address

Phone Number

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* 2. What is your connection to the event?

Injured on scene

Present, not injured

Family member or loved one killed

Friend killed

Friend, family, or loved one of someone present

Community member impacted by event

First Responder

Family, friend, loved one of first responder

Emergency medical staff

Service provider, clergy, or state/local government

Other (please specify)

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* 3. Are you completing this questionnaire on behalf of affected others in your household? If so, what are their ages?

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* 4. In which town do you live and/or do others you are completing on behalf of live?

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* 5. Are you interested in one-on-one support? What days and times work best?

Yes

Undecided

Preferred days/times, please be specific

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* 6. What type of support groups are you interested in at the center? Please specify age ranges.

I'm not interested in support groups at the center

Group type

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* 7. What days and times work best for support groups for you?

I'm not interested in support groups

Same as times listed in previous answer

Preferred days and times, please be specific

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* 8. What social activities would you like to see at the center? Some examples could be crafting, movie nights, open mic, social coffee/tea, picnic, sporting events, or book club.

I'm not interested in social events at the center

Types of events/activities I'm interested in

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* 9. What days/times work best for you for social activities?

I'm not interested in social activities at the center

Same as times listed in previous answers

Preferred days and times, please be specific

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* 10. What type of wellness activities are you interested in? Examples could include yoga, meditation, reiki, walking group, reflexology, or fitness classes.

I'm not interested in wellness activities through the center.

Types of wellness activities I'm interested in

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* 11. What days and times work best for you for wellness activities?

I'm not interested in wellness activities

Same as times listed in previous answers

Preferred days and times, please be specific

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* 12. What types of education/training/workshops at the center interest you? Examples could be social/emotional education, financial education, career development, parenting/family dynamics, or area resources. Please specify types and age ranges.

I'm not interested in education/training/workshops at the center

Topics of interest

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* 13. What days and times work best for you for education/trainings/workshops?

I'm not interested in education/trainings/workshops at the center

Same as times listed in previous answers

Preferred dates and times, please be specific

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* 14. Do you have any barriers to accessing the center?

Transportation

Financial

Time/Availability

Other (please specify)

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* 15. What types of events would you attend virtually?

Support Group

Wellness Activity

Education/Training/Workshop

Social Engagement

I prefer to attend in person

Other (please specify)

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* 16. Is there any other feedback you would like to provide to the center at this time?

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* 17. What is your preferred method of contact to receive updates and announcements from the center? Please share your contact information.

Phone Call

Text Message

E-mail

Physical Address

I do not wish to receive updates and announcements from the center

Contact information (phone, email, and/or physical address)