Community Member Brainstorm Form

Community Member Brainstorm Form

Over the next twelve months, the Community Liaison Team will be visiting towns within Ontario County to host community forums where residents have an opportunity to share their lived experiences and ideas through conversations. Cannot attend an in-person forum? We still want to hear your thoughts and/or ideas for possible solutions around the topics proposed or topics that need to be proposed.
Age *
Zip Code*
Race*

American Indian/Alaska NativeAsianBlack/African AmericanNative Hawaiian or Pacific IslanderWhiteOther
Ethnicity*

Hispanic or LatinoNot Hispanic or Latino
What is your experince with the criminal justice system?*

I have been incarceratedI have been arrestedI am the family member of someone who has been incarceratedNone of the aboveOther
Check all that apply to you:*

recieved/ing help from a non-profitrecieved/ing SNAP (food stamps)visited/ing food pantriesrecieved/ing help from a professional around my mental healthrecieved/ing help from a professional for Substance Use Disorderrecieved/ing help from family and friend for help with food, mental health, and/or substance usenone of the above
Tell us a little about what makes you love your community. . .
We based this form on a larger survey done by Ontario County. More than 500 people responded and three areas of priority emerged: mental health issues, access to food, and substance use disorder.

When referencing mental health, we want to know what you think are the barriers that might get in the way of our community members achieving the support they need to achieve mental wellness.

When referencing access to food, we want to hear your ideas about how to ensure every household/person in Ontario County has enough food to sustain their daily lives.

When we reference substance use disorder, we are talking about the impact that addiction has had on our community, and want to know if you have any ideas on how we might ease that pain.

Thank you so much for investing in our community; we could not do this without you.
In your opinion, inside your community what is the most important of these three topics? Mental health, access to food, or substance use disorder?*
Please describe what this topic looks like in your community:*
If you or someone you loved were experiencing a crisis around this topic, what would your first step be?*
While trying to resolve this crisis, real or imagined, what do you think would go well?*
What would not go well?*
If utilizing a service or organization to address this crisis, what would make you use that same service again if you had another need?*
What is the second most important of these topics? Please choose from mental health, access to food, and substance use disorder.
Do you have any pertainent ideas around the other two topics? If so, please share and indicate which topic you are commenting on (Mental health, access to food, substance use disorder).
As a community member, what other topics are important to you?
Is there anything we did not ask, that you want to share?
Should be Empty: