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Community Experience Survey

Share Your Experience

Help us identify patterns in public systems. You can share as much or as little as you want. You may remain anonymous.

If you are in immediate danger, call 911.

CONNECT AND UNITE TO GET INVOLVED

Community Experience Survey (Anonymous)

This short survey helps us understand what people experience when trying to get help from different systems. You can answer quickly. You do not need to explain anything unless you want to.

Areas of Experience

Have you ever had problems with law enforcement (police reports, interactions, or response)?
Yes
No
Have you ever had problems with DCFS or child protection services?
Yes
No
Have you ever had problems with the court system?
Yes
No
Have you ever had problems getting public assistance (food stamps, CAFÉ, etc.)?
Yes
No
Have you ever had problems with medical care or hospitals?
Yes
No
Have you ever had problems with domestic violence services or support?
Yes
No
Have you ever had problems with nonprofit or disaster assistance organizations?
Yes
No
Have you ever asked for help and did not receive it?
Yes
No

What Happened

When you tried to get help, what happened most often?
I received help
I received some help
I did not receive help
I gave up trying
How did the experience make you feel?
Supported
Confused
Ignored
Discouraged
Intimidated
How many times has this happened?
Once
2–3 times
4+ times
Ongoing

Optional

Optional

Optional: Share Your Information

You can leave this blank if you want to stay anonymous.

Optional

Optional

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