This survey is designed to help you:

1: Identify particular areas of need in the community you serve 
2: Establish capacity for your coalition.

Question Title

* 1. Coalition Information
Please, provide the name of your coalition, the name of your contact person, the contact person's email address, and the zip codes your coalition will serve.

Question Title

* 2. Please select the current community partnerships where these is an identified person(s) for collaboration.  Select all that apply.

Question Title

* 3. Are the following currently in place within your organization/coalition? Select all that apply.

Question Title

* 4. Select the resources your organization/coalition has access to.

Question Title

* 5. Has your organization/coalition completed a community or needs assessment to identify resources.  If yes, please forward document to mheyward@pmhcc.org.

Question Title

* 6. Please identify possible community concerns. Select all that apply.

Question Title

* 7. Does your organization/coalition have knowledge of substance misuse challenges in the community/neighborhood?

Question Title

* 8. Select problem substances.

T