**** Survey closes January 3, 2014 ****

On June 1, 2012, Washington State's "state-controlled" liquor stores closed, and hard liquor (such as vodka, whisky, rum) became available for sale in large stores that obtained a spirits sales license.

Since that time, many community members and store personnel have shared stories about experiences with theft of hard liquor from stores. State and local agencies working in substance abuse prevention are seeking to collect these stories more systematically, as they provide important information that can help Washington and other states in moving forward and continuing to prevent youth alcohol use and alcohol abuse.

If you have such a story, please take a few moments to fill out this form. You can fill it out multiple times if you wish. Please also feel free to share this survey link with anyone you know who may have a story to tell.

Additionally, if you have questions or would like to share a story over the phone, you can leave your phone number or email in the last box on this survey, and a member of the research team will contact you.

The information collected will be compiled into a summary report available in January 2014. No individuals will be named. We will name cities or counties, OR chain store names as shared in stories, but we will work to NOT identify individual stores in specific communities.

Thank you for your support.

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* 1. Which of the following best describes your role in the community?

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* 2. What Washington State city or county did this story about alcohol theft occur it?

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* 3. Please share your story/stories about thefts of alcohol/hard liquor that have happened since June 2012. (if possible, please include approximate dates, whether youth were involved, and what happened as a result of the incident/s)

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* 4. Please estimate the value or cost of the theft. (this means the value of alcohol that was stolen or destroyed)

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* 5. Please describe any other consequences of the event, such as injuries, changes in store personnel or staffing patterns, changes in store operations, or how the stolen liquor was distributed.

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* 6. Is there anything else you would like to say?
You are welcome to provide your name and contact information if you are willing to talk more about this story. Your name and information will not be included in any summaries or reports, unless you give your specific permission.