WA SPEAKS Survey

Welcome to WA SPEAKS!

Whether you're interested in becoming a WA SPEAKS speaker or hosting a WA SPEAKS speaker at your organization or event, you are helping to spread the word that people can and do recover.

WA SPEAKS speakers are individuals, and families that have experience in recovering from external stressors like mental health challenges, substance use challenges, and post-traumatic stress disorder. The information we collect ensures our voices are representative of our communities and it is not wholly disclosed to any other organization.

Please contact allwellconsulting@gmail.com with any questions or concerns.

Question Title

* 1. Please let us know how we can reach you.

Name

Organization

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Email Address

Phone Number

Question Title

* 2. Select your gender and list your preferred pronouns in the comment field.

Female

Male

X/non-binary

Prefer not to answer

Preferred pronouns:

Question Title

* 3. Please identify your lived experiences. Include as many as you want. For example, you can list challenges with substance use, mental health or both (co-occuring), Veteran, Military status, or First Responder status, LGBTQI experience, deaf and hard of hearing challenges, etc.

Substance use challenges

Mental health challenges

Both mental health and substance use challenges

Recovery and wellness

Military experiences

First responder, CRISIS direct service provider or something similar

Visible disability

Invisible disability

LGBTQI experiences

Other (please specify)

Question Title

* 4. Please select one or more of your ethnic origins or race.

Hispanic or Latino

American Indian or Alaska Native

Asian

Native Hawaiian or other Pacific Islander

Black or African-American

White

Prefer not to answer.

Question Title

* 5. Would your work with WA SPEAKS be affiliated with your organization?

Yes

Maybe

Question Title

* 6. Have you attended WA SPEAKS training?

Yes

Question Title

* 7. If you want to attend additional training, which of the following topics most interest you?

Parity between mental and physical health services

Understanding your audience

Using notes, gestures, and props effectively

Health Equity for historically marginalized individuals

Preparing and practicing to speak

Diversity, Equity, Inclusion, and Justice

Conquering stage fright

Organizing and writing your story

Not Applicable (N/A)

Other (please specify)

Question Title

* 8. Are you interested in hosting a speaker or panel of speakers at your organization, event, or meeting? If yes, on what topic?

Yes

Maybe

Other (please specify)

Question Title

* 9. If you are interested in joining our cadre of speakers, have you sent us a bio and photograph for our website, or is there anything else we should know to book you a speaking engagement?