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* 1. What is the name of the church you attend?

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* 2. Years as a member of the Church.

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* 3. What is your age?

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* 4. What is your gender?

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* 5. Which of the following best describes your current relationship status?

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* 6. What is your race or ethnicity?

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* 7. What is the highest level of education you have completed?

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* 8. Which of the following categories best describes your employment status?

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* 9. Do you identify with any of the following religions? (Select all that apply.)

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* 10. Mental Health is an issue that should be addressed by my church.

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* 11. During the past 12 months, myself or someone I know has experienced emotional or mental health problems that have impacted normal social and work activities.

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* 12. How likely are you to rely on your faith during a time of crisis - financial, emotional, work related, personal or familial?

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* 13. How likely are you to first seek help from your Pastoral/ Ministerial Leadership if you are experiencing depression, anxiety, or other mental health conditions?

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* 14. Is your church equipped to address the mental health needs of your congregation?

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* 15. If yes, how helpful are the programs used to address the mental health needs of your congregation?

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* 16. What programs or services is your church using to address the mental health needs of your congregation? (Select all that apply)

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* 17. How many children are you parent or guardian for and live in your household (aged 17 or younger only)?

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* 18. How concerned are you about your child’s mental wellbeing?

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* 19. How likely are you to rely on the church to influence and develop your child's spiritual wellbeing?

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* 20. Do you believe your church should play a more active role in addressing the mental wellbeing of your child?

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