Skip to content
EmpowerSurvivors Demographic & Satisfaction Survey
EmpowerSurvivors Survey
EmpowerSurvivors strives to serve our members well and aid in safe recovery. Please help us better serve our members by completing this short survey. Survivors helping survivors, this is what we do!
1.
EmpowerSurvivors is a safe space where I can receive support and healing.
True
False
2.
How likely are you to recommend EmpowerSurvivors?
Very likely
Likely
Neither likely nor unlikely
Unlikely
Very unlikely
3.
What programs or Groups are you involved in?
Facebook groups
Thursday evening peer group
Conversations Elizabeth
Saturday's somatic relief and meditation program
All of the above
4.
Have you ever used any formal mental health related services? (For example, receiving counseling, guidance, or help with something in your life from a professional or semi-professional provider.)
Yes
No
5.
What is your age group?
Under 18
18-24
25-34
35-44
45-54
55-64
65+
6.
What is your gender?
Female
Male
Trans
Other
7.
What is your racial or ethnic identity? (Select all that apply.)
African-American/Black
East Asian
Hispanic/Latinx
Middle Eastern
American Indian/Alaskan Native
Pacific Islander
South Asian
Southeast Asian
White
Other (please specify)
8.
What is your sexual orientation?
Asexual
Bisexual
Gay
Heterosexual or straight
Lesbian
Pansexual
Queer
None of the above, please specify
9.
What is the highest level of education you have completed?
Did not attend school
1st grade
2nd grade
3rd grade
4th grade
5th grade
6th grade
7th grade
8th grade
9th grade
10th grade
11th grade
Graduated from high school
1 year of college
2 years of college
3 years of college
Graduated from college
Some graduate school
Completed graduate school
10.
What is your approximate average household income?
$0-$24,999
$25,000-$49,999
$50,000-$74,999
$75,000-$99,999
$100,000-$124,999
$125,000-$149,999
$150,000-$174,999
$175,000-$199,999
$200,000 and up