Foundry Surrey Questionnaire Help us build a great Foundry in Surrey. We would love to hear from you! Question Title * 1. Please tell us who you are. Parent/Caregiver/Family Member Community Member Youth Ages 12-14 Youth Ages 15-18 Youth Ages 19-25 Service Provider Other (please specify) OK Question Title * 2. Do you live in Surrey? Yes No OK Question Title * 3. Please tell us your vision for the Foundy Surrey. What do you hope to see? OK Question Title * 4. What is the one most important thing Foundry Surrey must be? OK Question Title * 5. Please rank the following programs and services in order of the priority that you feel would best serve the needs of youth in Surrey. Drag the bars to order them. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 Addictions/Substance-Use Services 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 Autism Services 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 Doctor 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 Drop-In Counselling 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 FASD Services 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 First Nations Cultural Practice and Healing 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 Food Classes 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 Land-Based Healing 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 LGBTQ2 Supports 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 Nurse 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 Outdoor/Recreation Programs 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 Psychiatrist 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 Sexual Health Services 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 Wifi 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 Youth and Family Peer Supports OK Question Title * 6. Would you like to be involved in Foundry Surrey? Yes No OK Question Title * 7. If 'Yes', how can you help? Provide supports for service delivery Join the Youth Engagement Table Join the Family Engagement Table Donate Spread the word! If you would like to join a table, please leave your name, contact phone number and email address so we can connect with you! OK Question Title * 8. Is there anything else you want to share with us? OK Question Title * 9. Would you like to make a donation to support Foundry Surrey? Yes No OK NEXT
