Stigma Survey Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.How do you identify yourself? *MaleFemalePrefer Not to SayHow old are you? *Less than 1818-2526-4041-6465+Which of the following best describes you? *WhiteBlack or African AmericanHispanic/LatinoAmerican Indian or Alaska NativeAsianNative Hawaiian or Other Pacific IslanderMore than one raceOtherWhat is your highest level of education? *High School or LessGEDSome CollegeAssociate DegreeBachelor DegreeGraduate DegreeI would feel comfortable telling the following people that I had a mental health disorder. (Check All that Apply) *Significant OtherFamilyFriendEmployerAcquaintance/StrangerNo OneI would feel comfortable telling the following people that I had a substance use disorder. (Check All that Apply) *Significant OtherFamilyFriendEmployerAcquaintance/StrangerNo OneHave you heard of: (Check All That Apply)#ChangethelanguageASAP#EndStigmaASAPASAP (Alliance for Substance Addiction Prevention)STAND Above the InfluenceAdditional comments and/or changes you want to see happen in regards to mental health and substance use in your community?PhoneSubmit
