#
Sustainability Survey

Today's date: |  |  |

Community: |
State: |

### I. Demographic Information
1. What agency/organization do you represent?
Public mental health agency | Private organization representing mental health
Public health agency | Private organization representing health
Public child welfare agency | Private organization representing child welfare
Public education | Private organization representing education
Public juvenile justice agency | Private organization representing juvenile justice
Family organization |

2. Which of the following best describes your current position?
CMHS grant community project director | Agency/organization director or manager
Agency/organization staff member | Family organization member
Family member, not affiliated with an organization | Other (please specify):

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