COMMUNITY 

Survey

Welcome! Our goal is to better understand the needs of our regional communities so that we can focus our efforts on issues that matter to you. Your answers are anonymous and confidential. If you have any questions or concerns, please contact us at info@aboriginalcongress.com. Thanks again, you for taking the time to answer our survey.

SECTION 1: COVID-19
1. Please indicate what issues or areas of concern, given the current situation with COVID 19, you would like the ACAA to focus its attention on, for yourself and your community.
2. Next, after this pandemic has subsided and we have moved forward, please indicate what issues or areas of concern would you like the ACAA to focus its
    attention on, for yourself and your community. 
SECTION 2: Demographics

These first few questions ask some personal information about yourself that will help us better understand the unique characteristics and needs of those we serve. All responses will remain confidential. 

3. What is your age category?
4. What is your gender?
5. What is the level of education you completed?

6. What city, town, village do you live in?

7. Which of the following best describes your housing status?
8. Which of the following best describes your current relationship status?

9. How many people aged 18 and older do you live with?

10. How many children under the age of 18 live with you all or most of the year?

11. If you have children or other dependents (under the age f 18) in your care: What is your family situation? (select all that apply)
12. As an Indigenous person, how do you self identify?
13. Are you a Registered Status Indian as defined by the Indian Act?
14. Do you live on a reserve ("Indian Reserve" as defined by the Government of Canada)?
15. Did you or anyone in your family attend residential school? (check all that apply)
16. Were you or anyone in your family a part of the Sixties Scoop?
17. Did you or anyone in your family attend Day School?
18. Do you consider yourself a survivor of intergenerational trauma?
SECTION 3: Health

The following questions explore the condition of your personal health as well as access to health related programs and services. 

19. How would you rate your overall health?
20. How would you rate your mental health?
21. Please check any existing health conditions that may apply to you.
22. How easy is it for you to access the following health services in your community? (i.e. family doctor or walk-in clinic).
23. How easy is it for you to access the following health services in your community? Mental health services (i.e. counselling, group therapy, crisis intervention, etc.)
24. How easy is it for you to access the following health services in your community? Sexual and reproductive health services (i.e. STI testing, pregnancy supports, sexual education, etc.)
25. Do you have any health coverage/benefits from the following providers (check all that apply)
26. Which barriers (if any) do you face when needing to access health services in your community?

27. Is there anything you would like to share about the barriers you have when needing to access health services in your community? (optional)

SECTION 4: Social Services

The following questions explore the condition of your need for and access to social programs and services.

28. Do you or someone in your immediate family need the following eduational supports/services? (check all that apply)
29. In the past year, have you participated in/accessed the following Indigenous cultural practices and resources? (check all that apply)
30. Which of the following employment and income supports would you most like access to? (check all that apply)
31. In the past 5 years, how many times have you moved residences?
32. In the past 5 years, have you moved residences for any of the following reasons?
33. Which of the following housing services and supports would you most like access to? (check all that apply)
34. Do you have access to service providers who provide culturally appropriate/safe services in the area of physical health?
35. Do you have access to service providers who provide culturally appropriate/safe services in the area of mental health?
36. Do you have access to service providers who provide culturally appropriate/safe services in the area of educational support?
37. Do you have access to service providers who provide culturally appropriate/safe services in the area of employment supports?
38. Do you have access to service providers who provide culturally appropriate/safe services in the area of financial support?
39. Do you have access to service providers who provide culturally appropriate/safe services in the area of housing support?
40. Do you have access to service providers who provide culturally appropriate/safe access to culturally based activities and recreation supports?
41. Do you have access to service providers who provide culturally appropriate/safe services in the area of legal services and supports?

42. Are there any other culturally-appropriate services that you would like to have access to in your community (optional)

43. Is there anything you would like to share about the cultural appropriateness/safety of the services you access in your community? (optional)

44. Are there any other areas we did not address in this survey that you see as a priority for services and policy advocacy efforts (check all that apply)

45. Do you have any additional comments or concerns you would like to share?

46. Name of City, Town, Village Location in Alberta

47. Name 

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