Youth Community Assessment

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* 1. Age

Under 18

18-24

25-30

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* 2. What is your gender identity?

Woman

Man

Genderqueer or non-binary

Transgender - MtF

Transgender - FtM

Agender

Two Spirit

Not specified above, please specify

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* 3. What is your sex assigned at birth?

male

female

other

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* 4. What is your sexual orientation?

Asexual

Bisexual

Gay

Heterosexual or straight

Lesbian

Pansexual

Queer

None of the above, please specify

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

American Indian or Alaskan Native

Asian / Pacific Islander

Black or African American

Hispanic

White / Caucasian

Multiple ethnicity / Other (please specify)

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

Ballroom

Kiki

Both

none

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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?

Yes

Not sure

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

Yes

Yes, Did you find the services useful?

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

Yes

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

Extremely important

Very important

Somewhat important

Not so important

Not at all important

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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

inpatient substances use( in a facility for at least 21 days)

outpatient substance use

long term treatment( 6 month program at a residential facility)

harm reduction( if you use a substance, use safely with no judgement)

substance use individual and group counseling( space to help process feelings and thoughts about use)

psychotherapy( talk therapy)

Psychiatry( medication treatment for mental health conditions)

None of the above

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

inpatient substances use( in a facility for at least 21 days)

outpatient substance use

long term treatment( 6 month program at a residential facility)

harm reduction( if you use a substance, use safely with no judgement)

substance use individual and group counseling( space to help process feelings and thoughts about use)

psychotherapy( talk therapy)

Psychiatry( medication treatment for mental health conditions)

None of the above

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

Extremely useful

Very useful

Somewhat useful

Not so useful

Not at all useful

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* 14. 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.

Yes

Email Address?

Youth Community Assessment

Question Title

* 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

Question Title

* 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?

Question Title

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

Question Title

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

Question Title

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

Question Title

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

Question Title

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

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* 14. 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.

Question Title

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