This survey about mental health and aging resources is a project of the North Carolina Mental Health and Aging Coalition. By taking time to complete it, you will help us develop a directory of resources for adults aged 60 and older. Resources will include those targeting mental health, cognitive health and substance use issues. In addition, your responses will help clarify work that is needed to comprehensively address the problems of mental health and aging in North Carolina. The survey includes activities conducted by you or your organization, as well as needs in your area. The survey will be completed by healthcare, mental health and aging services providers, public health departments, senior housing personnel and others. Summary data will be shared in a series of regional workshops in 2013.

You may see all of your responses once you have completed the survey. You may also choose to receive a copy of the findings once they are compiled. Please let us hear from you!

You and Your Organization
The first section asks for contact information as well as information about your organization (or your practice if you are working independently). If there are multiple departments in your organization that should respond to this survey, please forward the survey information to them.

* 1. Kindly provide your contact information. Thank you!

* 2. What is the geographic focus of your organization or practice?

* 3. In what type of setting do you work (or volunteer)? Choose the best answer.