YPR Chapter Census | YPR - Young People In Recovery

Name*
First Last
Email*
Enter Email Confirm Email
Address*
City State ZIP Code
What is your age?*
What term best describes your gender?*
- Female
- Male
- Non-binary
- Prefer Not to Answer
Do you consider yourself to be:*
- Heterosexual or straight
- Gay
- Lesbian
- Bisexual
- Prefer not to answer
What is your race? Please select all that apply.*
- American Indian or Alaska Native
- Asian (includes East Asia, Southeast Asia & Indian subcontinent)
- Black or African-American
- Native Hawaiian or Pacific Islander
- White or Caucasian
- Prefer Not to Answer
What is your ethnicity?*
- Hispanic/Latinx Origin
- Not Hispanic/Latinx Origin
- Prefer Not to Answer
What is your highest level of educational attainment?*
- Middle school (no high school degree or GED)
- High school degree or GED
- Some College
- Associate’s degree
- Bachelor's degree
- Graduate degree (MA, Ph.D., JD, MBA, etc.)
- Prefer not to answer
How would you describe your current housing situation?*
- I am homeless, living in a homeless shelter, or other arrangement (like couch-surfing)
- I live in transitional housing like a sober home or halfway house
- I am a student & live in student dorms or other off-campus housing (including rentals)
- I live with my parents
- I rent my current apartment or house (either on your own or with roommates)
- I own my current apartment or house
- Prefer not to answer
How would you describe your current employment situation?*
- I am unemployed
- I am a full-time student with no other current occupation
- I am in school and have a part-time job
- I have a part-time job but am not in school
- I have multiple part-time jobs but would prefer a full-time one
- I have a full-time job
- Prefer not to answer
Please tell us about your current income level:*
- I make under $25,000 annually
- I make between $25,000-$49,999 annually
- I make between $50,000-$74,999 annually
- I make over $75,000 annually
- I don't know/prefer not to answer
How would you describe your criminal justice involvement? (Please check all that apply)*
- I am currently on parole or on probation
- The most severe charge I’ve ever faced is a misdemeanor
- The most severe charge I’ve ever faced is a felony
- I have served time in jail, prison or juvenile justice for a drug-related offense (includes crimes committed to support one’s own substance use disorder as well as distribution)
- I have served time in jail, prison or juvenile justice for a non-drug related offense
- I have never been charged with a misdemeanor or a felony
- Prefer not to answer
Have you visited the ER in the last month for a substance use crisis such as an overdose?*
- Yes
- No
- Prefer not to answer
In the past 30 days, have you visited a behavioral health specialist such as a therapist, peer specialist or psychiatrist for counseling or medication management for your substance use disorder?*
- Yes
- No
- Prefer not to answer
In the past 30 days, have you visited a healthcare provider for routine healthcare unrelated to your substance use disorder?*
- Yes
- No
- Prefer not to answer
Which chapter hosted the event?*
What type of YPR event did you attend?*
- All Recovery Meeting
- Education Workshop
- Housing Workshop
- Employment Workshop
- Financial Literacy Workshop
- Recovery Messaging Workshop
- Leadership Meeting/Business Meeting/Planning meeting
- Pro-social (Example: bowling, softball, holiday party, Ultimate Frisbee)
- Advocacy Workshop
- History of the Opioid Crisis Presentation
- YPR Overview Workshop
- Advocacy Event
Check as many events as you wish:
Would you recommend YPR to a friend?*
- Yes
- No
- Prefer not to answer