Office of Peace and Policy Survey

Thank you for taking this survey. Please complete all answers.

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* 1. Please provide the city you currently reside in.

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* 2. Please provide the county you currently reside in.

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* 3. Please select your gender.

Male

Female

Other:

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* 4. Please select your race.

White or Caucasian

Black or African American

Hispanic or Latinx

Asian

Native Hawaiian or other Pacific Islander

Bi-racial or multi-racial

Other (please specify):

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* 5. Please select your age group

Under 21

21 - 35

36 - 50

Over 50

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* 6. Do you have any of the following convictions?

Misdemeanor

Felony

Both misdemeanor and felony

Does not apply

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* 7. If so, in what correctional system did you or your loved one serve their sentence?

State

Federal

Does not apply

Comments:

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* 8. How long was the sentence served?

Less than a year

1 - 5 years

6 - 10 years

11 -20 years

20+ years

Not applicable

Comments:

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* 9. What impact has the novel coronavirus had on you and your loved ones? Please select all that have applied during the "shelter in place" period.

Loss of income due to loss of employment

Lack of food

Disconnection of utilities

Lack of housing or fear of eviction

Lack of access to healthcare

Inability to pay for prescribed medications

Inability to comply with court ordered requirements (community service, payment of fees, etc.)

Lost school time and inability for minor children to engage in outdoor activities.

Concern for the safety of currently incarcerated loved one

No impact or issues of concern

Other (please specify)

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* 10. Please select all of the items listed you believe are important to include in a reentry program. Please select all that apply.

Housing plan to address homelessness

Assistance with obtaining identification

Advocacy to clear outstanding fines and fees

Assistance in acquiring access to healthcare

Assistance in acquiring mental health treatment, including substance abuse counseling

Employment assistance in finding a job, apprenticeship and/or small business development

Educational assistance with obtaining a GED, college degree or trade certification

Assistance with reuniting with family

Periodic review of transitional homes to ensure safety and compliance

Connection to other formerly incarcerated individuals for peer support

Availability of emergency resources, such as utility and rent assistance, food, etc.

Assistance with voter registration, restoring the right to vote or education about voting.

Other: