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To provide better access to wellness in our community, we provide free mental health and wellness services to Indigenous and underserved communities and anyone who has been a victim of a crime. To meet the expectations of the Department of Justice Victims of Crime Act (VOCA) and to gain the funding necessary to provide free services, it helps us to learn more information about our community. This survey gives us insight into the experiences of who we are serving and helps us to adjust our services to the needs of our communities. 

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* 1. Date Survey Taken

Date

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* 2. Service Used/Event (choose all that apply)

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* 3. Race/Ethnicity/Tribe

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* 4. Gender

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* 5. Age

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* 6. Are you a Wisconsin Resident?

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* 7. If you are not a Wisconsin resident, what state do you reside?

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* 8. Have you or your family been impacted by any of the crimes listed in the next question?
If yes, please check all those that you or a family member has experienced:

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