Substance Misuse Prevention Evaluation
Please complete this evaluation to help us assess the effectiveness of our substance misuse prevention efforts. Your responses are confidential and will be used to improve our programs.
Demographic Information
Please tell us a bit about yourself.
Full Name
First Name
Last Name
Email Address
example@example.com
Age
*
Gender
*
Male
Female
Non-binary
Prefer not to say
What is your role?
*
Please Select
Student
Parent/Guardian
Teacher/Educator
Community Member
Other
Please indicate your level of agreement with the following statements:
*
Rows
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
I am aware of the risks associated with substance misuse.
1
2
3
4
5
I know where to seek help for substance misuse issues.
6
7
8
9
10
I feel confident in my ability to refuse substances if offered.
11
12
13
14
15
I believe substance misuse is a serious issue in my community.
16
17
18
19
20
In the past 6 months, have you participated in any substance misuse prevention activities or programs?
*
Yes
No
How would you rate the effectiveness of the substance misuse prevention program(s) you attended?
1
2
3
4
5
How likely are you to recommend these prevention programs to others?
*
Not likely at all
1
2
3
4
5
6
7
8
9
Extremely likely
10
1 is Not likely at all, 10 is Extremely likely
What suggestions do you have to improve our substance misuse prevention efforts?
Signature (please sign to confirm your consent)
*
Submit Evaluation
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