Participant Feedback Form Survey

Adult 65+ with multiple chronic conditions

People who are deaf or experience hearing loss

Formerly Incarcerated or recently released

LGBTQ+

People experiencing a substance use disorder or are in recovery

People experiencing homelessness

People experiencing mental health challenges

People living with HIV/AIDS

People with other disabilities

Rural residents

Veterans

Youth

Tribal Nation

	Strongly disagree	Disagree	Agree	Strongly agree
I could understand the data that was shared.	I could understand the data that was shared. Strongly disagree	I could understand the data that was shared. Disagree	I could understand the data that was shared. Agree	I could understand the data that was shared. Strongly agree
I think the Health Priorities that were chosen reflect the health needs of my community.	I think the Health Priorities that were chosen reflect the health needs of my community. Strongly disagree	I think the Health Priorities that were chosen reflect the health needs of my community. Disagree	I think the Health Priorities that were chosen reflect the health needs of my community. Agree	I think the Health Priorities that were chosen reflect the health needs of my community. Strongly agree
I felt comfortable sharing my views.	I felt comfortable sharing my views. Strongly disagree	I felt comfortable sharing my views. Disagree	I felt comfortable sharing my views. Agree	I felt comfortable sharing my views. Strongly agree
I understand how the information that was collected will be used.	I understand how the information that was collected will be used. Strongly disagree	I understand how the information that was collected will be used. Disagree	I understand how the information that was collected will be used. Agree	I understand how the information that was collected will be used. Strongly agree
I feel hopeful that sharing this information will be used to help my community.	I feel hopeful that sharing this information will be used to help my community. Strongly disagree	I feel hopeful that sharing this information will be used to help my community. Disagree	I feel hopeful that sharing this information will be used to help my community. Agree	I feel hopeful that sharing this information will be used to help my community. Strongly agree

Strongly disagree

Disagree

Agree

Strongly agree

I could understand the data that was shared.

I could understand the data that was shared. Strongly disagree

I could understand the data that was shared. Disagree

I could understand the data that was shared. Agree

I could understand the data that was shared. Strongly agree

I think the Health Priorities that were chosen reflect the health needs of my community.

I think the Health Priorities that were chosen reflect the health needs of my community. Strongly disagree

I think the Health Priorities that were chosen reflect the health needs of my community. Disagree

I think the Health Priorities that were chosen reflect the health needs of my community. Agree

I think the Health Priorities that were chosen reflect the health needs of my community. Strongly agree

I felt comfortable sharing my views.

I felt comfortable sharing my views. Strongly disagree

I felt comfortable sharing my views. Disagree

I felt comfortable sharing my views. Agree

I felt comfortable sharing my views. Strongly agree

I understand how the information that was collected will be used.

I understand how the information that was collected will be used. Strongly disagree

I understand how the information that was collected will be used. Disagree

I understand how the information that was collected will be used. Agree

I understand how the information that was collected will be used. Strongly agree

I feel hopeful that sharing this information will be used to help my community.

I feel hopeful that sharing this information will be used to help my community. Strongly disagree

I feel hopeful that sharing this information will be used to help my community. Disagree

I feel hopeful that sharing this information will be used to help my community. Agree

I feel hopeful that sharing this information will be used to help my community. Strongly agree

Participant Feedback Form

Question Title

* 1. Which community event did you recently participate in?

Question Title

* 2. Which community sectors do you represent (check all that apply)?

Question Title

* 3. Please rate the following statements:

Question Title

* 4. Who should we ask to provide further input? (Please provide their contact information if you can)

Question Title

* 5. Do you wish to share additional feedback about this process or about the health of your community?

Participant Feedback Form

Question Title

* 1. Which community event did you recently participate in?

Question Title

* 2. Which community sectors do you represent (check all that apply)? ﻿

Question Title

* 3. Please rate the following statements:

Question Title

* 4. Who should we ask to provide further input? (Please provide their contact information if you can)

Question Title

* 5. Do you wish to share additional feedback about this process or about the health of your community?

* 2. Which community sectors do you represent (check all that apply)?