NISA Membership Survey: Exploring video, phone-in, and online peer support
In the wake of COVID-19 and all us needing to stay home to protect everyone's health, NISA is exploring how we can keep the connections with our members going, in meaningful and safe ways. We are considering a number of options right now, and as always, we need you — our members — to guide us in this decision-making.

Please respond to the following questions to let us know how we can best connect with and support you right now.
Sign in to Google to save your progress. Learn more
Do you have regular access to the internet where you live?
Clear selection
On a scale of 1 to 5, how often do you use the internet?
Almost never
All the time!
Clear selection
Do you have access to a device (for example: a laptop, tablet or phone) that connects to the internet/wifi?
Clear selection
Does this device have a built-in camera and microphone?
Clear selection
Are you interested in participating in NISA programs through a free face-to-face video program with other members?
Clear selection
Would you prefer one-to-one or group-based video peer support?
Clear selection
What groups would interest you the most to participate in through a live video and with other members? Select all that apply
How often would you want to participate in a peer support group via video?
Clear selection
On a scale of 1 to 5, how interested are you in participating in a private Facebook message group just for members?
Not interested at all
Very interested
Clear selection
What is the best way that we can reach you to be included in these new, virtual, groups through NISA? (Please provide your phone number, email, or name that you use on Facebook for us to follow-up)
Can we add this contact information to your membership file so that we have it in the future?
Clear selection
What is the first and last name we know you by at NISA?
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Northern Initiative for Social Action. Report Abuse
Google Forms