2min Survey | Youth Mental Health Event by EMPWR & CMHA Peel Dufferin
EMPWR & CMHA Peel Dufferin recognize the mental health challenges youth face today and we want to help build the most supportive environment.

Please take this confidential and anonymous 2 minute survey.

Help us help you.

*Please include a 5 digit combination in the last question of today's survey.
**We'll be calling out 4 winners who complete the survey for a chance to win a $20 Starbucks gift card.
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1. Were you born in Canada? *
If NO, what year did you arrive in Canada?
2. What is your age group? *
Required
3. What is your gender? **CHECK ONE ONLY. *
If Other, please specify below:
4. What is your sexual orientation? **CHECK ONE ONLY. *
If Other, please specify below:
5. Overall, how would you rate your mental health? **CHECK ONE ONLY. *
6. Are you able to talk openly to your family and friends about the current status of your mental health? **CHECK ONE ONLY. *
7. Have you ever gone to therapy? **CHECK ONE ONLY. *
8. If yes, why do you go to therapy? If no, what would you go to therapy for? **Check all that apply.                               *
Required
If Other, please specify below:
9. During the past year how often have you felt sad, anxious or depressed? **CHECK ONE ONLY. *
10. During the past year has your mental health interfered with your personal relationships? (family relationships, friendships, relationships) **CHECK ONE ONLY. *
11. During the past year has your mental health interfered with your ability to work, accomplish tasks, or study? **CHECK ONE ONLY. *
12. What is one thing you wish your parents knew about mental health? *
13. Would you be interested in the CMHA forming a Youth Mental Health Advisory Council to help our community addressing and navigating solutions? **CHECK ONE ONLY. *
🎫 Please write a 5 digit combination below for the chance to win a $20 Starbucks Gift Card! ( Ex. 41523 ) ( Remember to note down your 5 digit combination for verification!)
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