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1. (Community Knowledge About Suicide Prevention) How much of a concern is suicide in your communities? (please rate on a Scale from 1 to 10 with 1 being "not at all", 10 being "all the time") (Required.)

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2. Do you feel your communities have sufficient efforts, programs or activities related to suicide prevention? (please rate on a Scale from 1 to 10 with 1 being "not at all", 10 being "all the time") (Required.)

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3. Are the programs, efforts or activities sufficient to reduce suicide? (please rate on a Scale from 1 to 10 with 1 being "not at all", 10 being "all the time") (Required.)

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4. If your communities have programs, efforts or activities, how aware are community members? please (rate on a Scale from 1 to 10 with 1 being "not at all", 10 being "all the time") (Required.)

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5. Do your communities have any protocols in effect related to suicide prevention? (please rate on a Scale from 1 to 10 with 1 being "not at all", 10 being "all the time") (Required.)

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6. (Community Leadership) How much of a concern is suicide to the leadership in your communities? (please rate on a Scale from 1 to 10 with 1 being "not at all", 10 being "all the time") (Required.)

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7. Are the leaders in your communities involved in efforts to reduce suicide? (please rate on a Scale from 1 to 10 with 1 being "not at all", 10 being "all the time") (Required.)

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8. Would leadership in your communities support additional efforts, programs and activities? (please rate on a Scale from 1 to 10 with 1 being "not at all", 10 being "all the time") (Required.)

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9. (Community Climate) Is the communities' attitude about suicide prevention very positive? (please rate on a Scale from 1 to 10 with 1 being "not at all", 10 being "all the time") (Required.)

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10. Are there any obstacles in your communities to impede efforts for suicide prevention? (please rate on a Scale from 1 to 10 with 1 being "not at all", 10 being "all the time") (Required.)

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11. How supportive or involved are the communities with suicide prevention efforts? (please rate on a Scale from 1 to 10 with 1 being "not at all", 10 being "all the time") (Required.)

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12. (Knowledge) Is there information available to community members regarding suicide? (please rate on a Scale from 1 to 10 with 1 being "not at all", 10 being "all the time") (Required.)

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13. Are community members knowledgeable about suicide prevelance, signs and symptoms of sucide? (please rate on a Scale from 1 to 10 with 1 being "not at all", 10 being "all the time") (Required.)

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14. Is there sufficient data available about suicide in your communities? (please rate on a Scale from 1 to 10 with 1 being "not at all", 10 being "all the time") (Required.)

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15. (Resources for Prevention) Are community members' attitude supportive for reducing suicide? (ie: people volunteer, make financial donations, provide space, etc.) (please rate on a Scale from 1 to 10 with 1 being "not at all", 10 being "all the time") (Required.)

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16. Are you aware of any proposals or action plans that have been written to address suicide prevention? (please rate on a Scale from 1 to 10 with 1 being "not at all", 10 being "all the time). (Required.)

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17. Additional Comments?

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18. What is the name of your agency? (Required.)

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19. Choose the category that best describes your agency? (Required.)

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20. Choose the county where you work/ volunteer? (Required.)

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