JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
The Canadian Association of People who Use Drugs- Evaluation questionnaire
CAPUD received funding from Health Canada’s Substance Use and Addiction Program (SUAP) to support our work. CAPUD is required to collect information to support the evaluation of the project. We would really appreciate it if you could take a few minutes to answer the ev questions. Your participation is essential to our work and we need your feedback to understand if we are meeting the needs of our community and stakeholders throughout Canada.
Thank you in advance!
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Do you identify as …? / Vous identifiez-vous comme…?
*
Agender / Agenre
Gender Fluid / Genre fluide
Gender Queer / Genre Queer
Man / Homme
Non-binary / Non-binaire
Transgender / Transgenre
Two-Spirit / Bi-spirituelle
Woman / Femme
In another way / D’une autre manière
I don’t want to say / Je préfère ne pas l’indiquer
Other:
Do you identify as …? / Vous identifiez-vous comme une personne …?
*
Black, African, Caribbean / Noire, Africaine, Caraïbes
Indigenous (First Nations, Metis, Inuit) / Indigiène (Premières nations, Métisse, Inuit)
Person of Colour (Asian, Pacific Islander, Latinx) / Personne de couleur (asiatique, des îles du Pacifique, de l’Amérique latinx)
In another way / d’une autre manière
Other:
Where do you live? / Où habitez-vous?
*
British Columbia / Colombie-Britannique
Alberta
Saskatchewan
Manitoba
Ontario
Quebec/Québec
New Brunswick / Nouveau-Brunswick
Prince Edward Island / Île-du-Prince-Édouard
Nova Scotia / Nouvelle-Écosse
Newfoundland & Labrador / Terre-Neuve et Labrador
Northwest Territories / Territoires du Nord-Ouest
Nunavut
Yukon
Outside of Canada / À l’extérieur du Canada
Which of these terms best describes where you live? Lequel de ces termes décrit le mieux votre lieu de résidence?
*
Urban (City living)/Urbain (Vivre en ville)
Suburban (A residential district located on the outskirts of a city)/Suburban (Un quartier résidentiel situé à la périphérie d'une ville)
Rural (Rural areas, often called "the country")/Rural (zones rurales, à la campagne )
Remote (out-of-the-way; secluded: eg. a remote village; a remote mountaintop)/Éloigné (hors du chemin ; isolé : par exemple, un village isolé ; un sommet de montagne isolé)
First Nation, Métis or Inuit community/Communauté Autochtone, Métisse ou Inuite
Other:
Which perspective or stakeholder group(s) do you represent? (select all that apply) / Quel(s) point(s) de vue ou quel(s) groupe(s) d’intervenant(s) représentez-vous? (cochez tout ce qui s’applique)
*
Academic Institution/Institution académique
Community or social service/Communautaire ou services sociaux
Government – non-elected/Gouvernement - non élu
Health service/Services de la santé
Person who uses/used drugs /Personne qui consomme ou qui a consommé des substances
Police/law enforcement/Police/force de l’ordre
Public health/Santé publique
Other perspective or stakeholder group/Autre point de vue ou intervenant
Other:
What languages do you use? (select all that apply) / Quelle langue utilisez-vous le plus souvent? (cochez tout ce qui s’applique)
*
English/Anglais
French/Français
In another way/D’une autre manière (eg. Indigenous, First Nations, Metis, Inuit) language/ Indigiène (Premières nations, Métisse, Inuit) langue
Other:
How familiar are you with CAPUD and the work we do?/Connaissez-vous CAPUD et notre travail?
*
Unfamiliar/Inconnue
Slightly familiar/Un peu familier
Moderately familiar/Moyennement familier
Very familiar/Très familier
Next
Page 1 of 5
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.
Report Abuse
-
Terms of Service
-
Privacy Policy
Forms
