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Counseling Center/PRT Community Stakeholder Survey
1.
Are you aware of what programs our Counseling Center campus offers?
Yes
No
2.
What is your zipcode
3.
Age
Under 18
18-24
25-34
35-44
45-54
55-64
65+
4.
Which gender do you identify most with
Male
Female
Prefer not to say
5.
What barriers if any prevent you or your loved ones from seeking or receiving care?
Lack of transportation
Concerns with privacy
Unaware of services offered
Scheduling conflict
Unsure if I would benefit from services
None of the above
Other (please specify)
6.
Are you or someone you know experiencing addiction?
Yes
No
Other (please specify)
7.
In general, how would you rate your overall mental or emotional health?
Excellent
Very good
Good
Fair
Poor
8.
When did you last get your mental health examination done?
Currently seeing a mental health professional
less than 6 months
Within the last year
Over a year
Never
Other (please specify)
9.
What is your tribal affiliation?
Osage
Cherokee
Ponca
Pawnee
Quapaw
Creek
Non- Native
Other (please specify)
10.
Living Status?
Homeowner
Renter
Living with Family
Temporary Housing
Homeless
Prefer not to say