1.Please indicate whether you are a (check all that apply)

Community member

Family member of person with substance use disorder

Law enforcement

Person in active use

Person in recovery

Prevention agency

Recovery support services provider

School personnel

Treatment provider

Educational professional

Elected/Government official

Other (please specify)

2.What age group do you represent?

Under 1818-2425-3435-4445-5455-6465+

3.What Race/Ethnicity do you identify with?

4.What is your Gender identity?

5.What is your municipality of residence?

AberdeenAllenhurstAllentownAsbury ParkAtlantic HighlandsAvon-by-the-SeaBelmarBradley BeachBrielleColts NeckDealEatontownEnglishtownFair HavenFarmingdaleFreehold BoroFreehold TownshipHazletHighlandsHolmdelHowellInterlakenKeansburgKeyportLake ComoLittle SilverLoch ArbourLong BranchManalapanManasquanMarlboroMatawanMiddletownMillstoneMonmouth BeachNeptune CityNeptune TownshipOceanOcean GroveOceanportRed BankRooseveltRumsonSea BrightSea GirtShrewsbury BoroShrewsbury TownshipSpring Lake HeightsTinton FallsUnion BeachUpper FreeholdWallWest Long Branch