1.) What is your gender?

 Male
 Female

2.) What is your age?

3.) What is your ethnicity?

 Hispanic or Latino
 Not Hispanic or Latino

4.) What is your race? Select only one that best describes your race.

 White
 Black or African American
 American Indian or Alaska Native
 Asian
 Native Hawaiian or Other Pacific Islander
 More Than One Race
 Other

5.) In what township, borough, town, or ciy do you reside? Please indicate the community where you physically live, even if it is different from the community described above.

6.) In what county do you live?

7.) How long have you been involved in your current capacity in the specified community?

 Less than 2 years
 2 - 5 years
 reater than 5 years

Please answer the following questions considering the community described at the beginnng of this survey. Tell us how much you agree or disagree with the following statements about how members of your community feel about the following:

8.) Residents feel at home in our community?

 Strongly Agree
 Agree
 Neither Agree nor Disagree
 Disagree
 Strongly Disagree

9.) The members of the community want the same thing.

 Strongly Agree
 Agree
 Neither Agree nor Disagree
 Disagree
 Strongly Disagree

10.) Drug use is tolerated in the community.

 Strongly Agree
 Agree
 Neither Agree nor Disagree
 Disagree
 Strongly Disagree

11.) The residents like their community.

 Strongly Agree
 Agree
 Neither Agree nor Disagree
 Disagree
 Strongly Disagree

12.) Alcohol use by minors is tolerated in our community.

 Strongly Agree
 Agree
 Neither Agree nor Disagree
 Disagree
 Strongly Disagree

13.) Most residents feel safe in our community.

 Strongly Agree
 Agree
 Neither Agree nor Disagree
 Disagree
 Strongly Disagree

14.) Laws against having weapons in school or on school property are strictly enforced in our community.

 Strongly Agree
 Agree
 Neither Agree nor Disagree
 Disagree
 Strongly Disagree

15.) Most residents would like to get out of our community.

 Strongly Agree
 Agree
 Neither Agree nor Disagree
 Disagree
 Strongly Disagree

16.) Most resident are proud of the community.

 Strongly Agree
 Agree
 Neither Agree nor Disagree
 Disagree
 Strongly Disagree

17.) Schools in our community support "no use" messages about tobacco, alcohol and other drugs.

 Strongly Agree
 Agree
 Neither Agree nor Disagree
 Disagree
 Strongly Disagree

18.) Community churches and faith-based organizations support "no use" messages about tobacco, alcohol and other drugs.

 Strongly Agree
 Agree
 Neither Agree nor Disagree
 Disagree
 Strongly Disagree

19.) Law enforcement agencies support "no use" policies about tobacco, alcohol and other drugs.

 Strongly Agree
 Agree
 Neither Agree nor Disagree
 Disagree
 Strongly Disagree

20.) People in our community share the same values.

 Strongly Agree
 Agree
 Neither Agree nor Disagree
 Disagree
 Strongly Disagree

21.) Community members have influence in our community.

 Strongly Agree
 Agree
 Neither Agree nor Disagree
 Disagree
 Strongly Disagree

 

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