Request edit access
Peer Support Space's Community Needs Assessment
Peer Support Space (PSS) wants to hear from you! Please take some time to share your thoughts by filling out the following, anonymous survey, to the best of your abilities. All questions are voluntary. If you would like to reach out to us about anything directly, please contact Dandelion at Dandelion@peersupportspace.org or visit our website at PeerSupportSpace.org.
Sign in to Google to save your progress. Learn more
I agree to allow Peer Support Space, inc. to use information (name will not be included) from this survey for program development, marketing and fundraising purposes (testimonials, satisfaction data, etc.) *
How do you identify for your race/ ethnicity? (Please select all that apply)
What is your age?
Clear selection
Please describe your gender identity (e.g transgender, non-binary, agender, cisgender, etc.)
Please describe your sexual orientation (e.g gay, lesbian, queer, heterosexual, etc.)
What is your zip code?
Have you ever used Peer Support Spaces resources?
Clear selection
What opportunities for growth do you see for PSS's current resources?
Have you had challenges finding mental health support & resources?
Do you feel like the same communities get repeatedly left behind when it comes to having accessible, quality mental health services?
Clear selection
If yes, which communities do you feel lack access?
Do you feel ashamed at times for having your own mental health challenges?
Clear selection
In what ways do you think mental health is stigmatized?
Do you feel like our mental health system has more of a focus on crisis care than prevention and sustainability?
Clear selection
The following question is for internal use as we recommend resources for one another. Do you feel comfortable anonymously naming any community providers (therapists, organizations etc.) that you either strongly recommend or strongly don't recommend? Why?
Have you ever been involuntarily hospitalized + how was that experience?
In what ways do you practice self-care?
What Community Gatherings/Activities do you wish PSS had?
What kind of mental health advocacy initiatives would you like to see Peer Support Space cover?
What else would you like to share with us about PSS? Do you have any additional comments?
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Peer Support Space. Report Abuse
Google Forms