Suicide Prevention Survey Question Title * 1. Which of the following do you represent Social Services Public Health Not for Profit Public Safety Citizen Volunteer For Profit Business Faith Based Government/ Governmental Agency Other OK Question Title * 2. What city or county is considered your permanent residency? Caroline Fredericksburg City King George Spotsylvania Stafford Regional/ Multi-jurisdictional Other OK Question Title * 3. What city or county/counties do you represent? Please check all that apply. Caroline Fredericksburg City King George Spotsylvania Stafford Regional/ Multi-jurisdictional Other OK Question Title * 4. Age 14 - 21 22 - 29 30 - 45 46 - 59 60+ OK Question Title * 5. Gender Female Male Prefer not to say Other OK Question Title * 6. Please rank the list of issues facing suicide prevention (add other issues if needed) 1 2 3 4 5 6 7 Stigma (e.g. Fear of talking about or acknowledging suicide) 1 2 3 4 5 6 7 Lack of supportive resources 1 2 3 4 5 6 7 Lack of suicide prevention trainings 1 2 3 4 5 6 7 Trouble accessing treatment or services 1 2 3 4 5 6 7 Lack of access to prevention and treatment resources 1 2 3 4 5 6 7 Lack of awareness of prevention and treatment resources 1 2 3 4 5 6 7 Other OK Question Title * 7. Additional issues from Question 6 (if any) Issue 1 Issue 2 Issue 3 OK NEXT
