Hope Lives - Vive La Esperanza (VHL)
Hope Lives - Vive La Esperanza (HLVLE) is a Multi-cultural community Peer Run Organization (PRO) and was established in 2010; to address growing barriers to care for under-served populations and communities.

As a PRO, the services and resources we offer are developed and nurtured around the needs of the community; to provide culturally relevant services to culturally divers communities.

We welcome comments that will help us improve or adjust services and achieve our vision. In order to best evaluate survey feedback, please make sure that each individual in a household complete a survey so please have each adult complete a survey.

No personal or identifying information is requested on this form. Once you complete the survey it is uploaded to a spreadsheet that allows HLVLE to best assess the needs of our community. All survey participants remain anonymous.

Citizen Survey - General Demographics
This first section of the survey collects demographic information about the particpant
What additional services/activities would you like offered in your community? Or, offered by HLVLE? (i.e gardening, exercise, nutrition, meditation, multicultural, etc.)
Your answer
Which Hope Lives Center location do you attend?
What types of information would you like to see presented on the website for HLVLE?
Your answer
What program(s) do/did you attend that you most enjoy?
Your answer
What has changed in your life since coming to HLVLE?
In which of these improvements has HLVLE played a part?
Your answer
Do you expect to return to work or school?
What can HLVLE do to support your goals?
Your answer
Employment Self Assessment - Overall, how would you rate the following statements?
I believe working in the community is good for me?
I feel I understand the requirements and demands of working
I know what type of work I can do
I have marketable skills
I understand the impact of work on my benefits
I can access transportation on my own
I can maintain a schedule
I am independent
I am not concerned about my legal history and work
I am satisfied that my education will help me find a job I want
I have the ability to take care of myself
I feel physically able to work
I know my preferences about work
I have a good support system
I believe I will be working in 3-6 months
Is working a goal on your ISP? *
If working IS a goal on your ISP, what supports and/or resources are listed as steps towards meeting your goal of working?
Your answer
How long have you been participating at Hope Lives?
What is your gender (select one)?
What year were you born?
Your answer
Have you served in the armed forces/military?
If you replied yes to the last question, are you receiving treatment of any kind as a result of active duty?
Please choose the answer(s) that best describes your race/ ethnicity? (you may choose more than one)
Have you been told by a health professional (such as a doctor, psychiatrist, psychologist or nurse practitioner) that you currently have any of the following behavioral health disorders / mental illnesses? (please select all that apply)
How much schooling did you complete? (select only the highest level completed)
How many times in your LIFETIME have you been:
Never (0)
1 - 3 Times
4 - 6 Times
7 or More Times
Hospitalized for psychiatric, suicidal thoughts of suicide, mental or emotional reasons
In-patient drug or alcohol treatment or detox
Spent time in Jail or Prison (as an adult only)
Been on Parole / Probation / Electronically Monitored / Random drug testing
Participated in City Mental Health Courts
Participated in DUI / Drug Court
Superior Problem Solving Court
Suicide attempt resulting in medical hospitalization
Suicide attempt resulting in psychiatric treatment
Homeless for 12 continuous months
Court Ordered for treatment
OR / Bail
Charges dismissed
Plea of Probation
Prison Plea / Sentence
Arrested and Jailed
County or Reservation booked out of?
Your answer
County / Reservation released to?
Your answer
How many times have you been homeless for any length of time in the PAST 3 YEARS?
Never submit passwords through Google Forms.
This form was created inside of Vive Hope Lives.