Cole Resource Center BRIDGE Forward Inquiry Survey
Thank you in advance for completing this survey. It has been designed so that CRC can best understand and meet the varied needs of our community. It should take no more than 5 minutes to complete and will allow us to meet with you to discuss our services. There are 4 sections of questions: Basic Info, Service Needs, Wellbeing, and Demographics. You may elect to skip any or all of the demographic section by selecting "Prefer not to say." Please note that we do not ask or require information about mental health conditions; by completing this survey, we assume that you meet the eligibility criteria of "living with a mental health challenge" and are seeking our specific services for that reason.
Meeting Criteria
Please note that in order to meet with CRC you must have access to a device and stable connection for Zoom meetings and that, regrettably, at this time, CRC is only able to offer services in English.
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First Name (how you would like to be addressed by us)
*
Last Name
*
Legal Name (if different, and only if you would like to provide it.)
Email
*
example@example.com
Current Residential Zip Code
*
CRC can only serve individuals in Massachusetts; please provide a home or school zip code in Massachusetts
Current age (in years)
*
CRC can only serve individuals who are over the age of 18.
How did you hear about CRC and/or BRIDGE Forward?
*
Please Select
Family Member or Friend
Saw a Flyer or Postcard
School Staff
Clinical Referral
Internet Search
Other
If you were referred by a clinician, please provide their name and place of work.
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CRC Services Questions
Where are you in your decision-making process about your education?
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I am considering stopping/pausing my education but am still enrolled.
I have stopped/paused my education in the last 3 months.
I have stopped/paused my education more than 3 months ago.
None of these.
How long (in months or years) has it been since you stopped attending school?
What will success look like to you after engaging with the program? Check all that apply.
*
Deciding what to do next
Feeling less alone
Building more mental well-being
Maintaining my well-being
Finding a volunteer opportunity
Returning to school
Finishing school
Getting a part-time job
Prefer not to say
Other
How much time have you put toward school so far?
*
Please specify completed months/years or semesters.
What degree are/were you pursuing?
*
Please Select
High School/GED
Associate's
Bachelor's
Master's
Doctorate
Other type of certification
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Current Support for Wellbeing
Who is providing the most support to you right now? Check all that apply.
*
Therapeutic Team
Family
Friends
School peers
School Clinical Staff
Professors/other academic staff
School Administrative Staff (not professors or clinicians)
Other
Prefer not to say
In general, how supported do you feel right now?
*
Very Supported
Somewhat supported
Not Supported At All
Prefer Not to Say
With regard to your next steps, how supported do you feel right now?
*
Very Supported
Somewhat Supported
Not Supported At All
Prefer Not to Say
In the past month, how often have you felt lonely or disconnected from others?
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All of the time
Most of the time
Some of the time
Not at all
Prefer not to say
Other
How important is it to establish a meaningful connection with a coach during your time at CRC?
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Very important
Somewhat important
Not important at all
Prefer not to say
How important is it to establish connections with mental health peers during your time at CRC?
*
Very important
Somewhat important
Not important at all
Prefer not to say
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Demographic Information
Preferred Pronouns (leave blank if you prefer not to say)
What race or ethnicity best describes you? Check all that apply.
*
American Indian/Alaska Native
Asian/ Pacific Islander
Black or African American
Hispanic
White/ Caucasian
Multiple Ethnicities
Other
Prefer not to say
What primary languages do you speak at home? (leave blank if you prefer not to say)
Do you now or have you ever served in the U.S. military or otherwise qualify for Veteran/military status?
*
Yes
No
Prefer not to say
Voluntary self-identification of disability status:
*
Yes, I identify as having or have a history/record of having a disability.
No, I do not identify as having or have a history/record of having a disability.
I prefer not to answer.
What best describes your current gender identity?
*
Woman
Man
Transgender
Non-binary
A gender not listed here
Prefer not tosay
Which of these best describes your current sexual orientation?
*
Asexual Spectrum
Bisexual
Gay/Lesbian
Heterosexual/Straight
Pansexual
Queer
A sexual orientation not listed here
Prefer not to say
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Thank you for taking the CRC Workforce Program Intake Survey. Please click "submit" if you are finished. Select "Back" if you would like to review or change any answers.
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