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First Name*

Last Name*

Email *

Age *
Under 18 years old18 years or older

Address: *

If you are a parent of a student(s) in the Northport - East Northport School District, please tell us which schools your children currently attend:

ElementaryMiddle SchoolHigh SchoolOther:

Have you or your family attended a Task Force event, workshop or program in the last 12 months? If so, which one? *

Have you volunteered at a Task Force event, workshop or program in the last 12 months? If so, which one?

Have you attended one of the Task Force's monthly meetings (via zoom) in the last 12 months?
YesNo

How do you usually find out about upcoming Task Force meetings, Event, Workshops, or Programs: *

EmailFacebookInstagramTask Force WebsiteLibrary NewsletterLocal NewspaperWord-of-MouthOther:

Our Task Force is comprised of people from various sectors of our community. Please tell us which sector you represent: *

SchoolsParentsStudent/YouthYouth-Serving OrganizationHealthcare ProfessionalsBusiness CommunityReligious/Fraternal OrganizationsCivic/Volunteer GroupLaw Enforcement AgencyState/Local Government AgencyOther Organization with Expertise in Substance AbuseOther:

We value your opinion. What do you think the Task Force can do more effectively? *

How would you like to be involved with the Task Force? *
Help organize an event?Help to publicize what we do?Volunteer at an event?Host a Task Force speaker at your organization?Support us financially or assist with fundraising?Behind the scenes (paperwork, data input, etc.)Other:

How do you see your role in the community? *

What type of activities or programs would you like to see more of? *

How likely are you to recommend a friend? *
LikelyNeutralUnlikely

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