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* 1. Age

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* 2. What is your gender identity?

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* 3. What is your sex assigned at birth?

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* 4. What is your sexual orientation?

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* 5. Which race/ethnicity best describes you? (Please choose only one.)

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* 6. Are you affiliated with the kiki or ballroom community? Please select which group below

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* 7. Do you know of resources or programs in NYC for LGBTQ Youth in or out of Ballroom struggling with substance use or mental health conditions?

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* 8. Have you ever accessed youth focused substances use or mental health services before?

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* 9. Have you ever experienced challenges trying to access youth focused substance use and mental health related services? 

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* 10. How important are substance use and mental health services for LGBTQ youth in and out of the ballroom community?

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* 11. Which of the following services would you like to seem more of at youth focused LQBTQ programs? select all that apply 

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* 12. How useful are the services  provided by Ballroom, We Care? 

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* 13. Are you in need of any assistance or resources for yourself or loved one combatting addiction or mental health services? If yes, please leave your email in the section below.

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* 14. Please provide us with your email address to receive your virtual gift card

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