Community Needs Assessment Survey
Share your perspective on youth challenges, protective factors, and service gaps to help shape local prevention priorities.
Participant Information
Age
*
Under 12
12–15
16–18
19–24
25+
Tribal affiliation
County of residence
Which best describes you?
*
Youth
Parent/Caregiver
Educator
Tribal Employee
Community Member
Healthcare Provider
Other
Community Needs
What are the biggest challenges facing youth in your community?
*
Alcohol use
Cannabis use
Prescription drug misuse
Opioid use
Mental health concerns
Bullying
Lack of activities
Transportation
Family stress
Other
What prevention topics would you like to see offered?
*
Healthy decision-making
Mental wellness
Coping skills
Substance use prevention
Medication safety
Overdose prevention
Leadership
Cultural activities
Healthy relationships
Other
Program Interests
Which activities would you or your family participate in?
Talking Circles
Cedar Box Classes
Hand Drum Making
Traditional Arts
Family Nights
Community Meals
Youth Leadership
Volunteer Opportunities
Wellness Events
Prevention Workshops
What additional activities would you like TOR to offer?
Would you like information about joining the Youth Advisory Council?
*
Yes
No
Name (Optional)
First Name
Last Name
Email (Optional)
example@example.com
Phone Number (Optional)
Please enter a valid phone number.
Format: (000) 000-0000.
Submit
Should be Empty: