YPR Chapter Census | YPR - Young People In Recovery

Name*

First Last

Email*

Enter Email Confirm Email

Location*

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:*

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?*

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?*

Check as many events as you wish:

Would you recommend YPR to a friend?*

Yes
No
Prefer not to answer