Survey for when Anemoni Supports Not AvailablePlease enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.This brief survey should only be used when you are seeking support through Anemoni Peer Respite and the wait list for the support you are seeking (Anemoni House, Mobile Support or both) is full.This survey is strictly for the purpose of gather information to advocate with funders about the demand for peer respite and mobile support.What type of support were you seeking? *Anemoni HouseMobile SupportI was open to bothWhere are you located? (city//town in Massachuetts) *Are you currently: *At home in an apartment, house or similarAt a friend or family member’s homeAt an Emergency RoomIn a locked psychiatric unitAt a clinical crisis respiteWith police or in jailIn a homeless shelterLiving on the street, in a tent, in a car or similarPlease share anything you want to share about the impact of Anemoni House and/or Mobile Support not being available right now. (Specifically, if you want to share something about the impact for the purpose of advocating for more peer respites, that could be helpful in the future!)Optional Demographic InformationIt can be helpful to our advocacy for more respites to be able to demonstrate the range of people seeking peer respite supports.You are welcome to answer or not answer any of the questions below.Your age range18 – 2425 – 3435 – 4445 – 5455 – 6465+How do you describe your race?How do you describe your gender?How do you describe your sexual orientation?What language do you prefer to speak?EnglishSpanishAmerican Sign LanguageOther you to of Are you a first or second generation immigrant?Yes, first generation (I came here from another country)Yes, second generation (I was born here, but my parents came here from another country)NoAre you disabled?Yes, I have a physical disability (deaf, blind, paraplegic, etc.)Yes, I have a cognitive or neurological disability (autism, dyslexia, etc.)Yes, I have a psychiatric disability.Yes, other.NoSubmit
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