Friendship Squad Friends Questionnaire

Full Name

E‐mail*

To ensure that The Friendship Squad is an accurate representation of the mental health & substance use community, please answer the following questions.
(YOU MAY LEAVE ANY QUESTION BLANK THAT YOU PREFER NOT TO ANSWER):

Please indicate your gender identity:

Please indicate your race/s and ethnicity/s:

Age:
18 – 24 years25 – 44 years45 – 64 years65 years & over

Do you consider yourself to be a part of the LGBTQ+ community?
YesNo

Haveyou ever experienced domestic violence?
YesNo

Are you a survivor of being incarcerated in prison or jail?
YesNo

Have you ever experienced homelessness?
YesNo

Are you currently receiving mental health services?
YesNo

Are you currently receiving substance use services?
YesNo

Have you ever received mental health services?
YesNo

Have you ever received substance use services?
YesNo

Are you a military veteran?
YesNo

Are you able to connect via
zoomsmartphonetabletcomputertelephonetext

What are your creative outlets of expression?

What are your hobbies?

Essay Questions (your essays will be reviewed as part of the pairing process)
What are the most important things that you want from a friend?

What life experiences do you feel that you and your friend should have in common?

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