Mental Health Stigma Questionnaire
The purpose of this survey is to assess general feelings of stigma about mental illness in our community, but will not be used as part of a formal research study. If you choose to be entered into the drawing for an Amazon gift card for completing this survey, you can enter your email at the conclusion of this form. Your responses to the other survey questions will be separated from your email.

Interested in being a podcast guest? Fill out form here: https://forms.gle/maUrTqiGSjJ2S5bBA
Listen to the podcast here! https://open.spotify.com/show/1fK0NRJTgi3sHd53BDZhV6
Sign in to Google to save your progress. Learn more
Do you wish to participate in this survey? *
Please note that by participating in this survey you are consenting to respond to questions that might be sensitive in nature, although you may choose not to respond to any question for which you do not wish to respond. We respect your right to privacy and we are committed to protecting the confidentiality of your personal information. This form has been adapted with reasonable measures to prevent loss, misuse and alteration of the information under our control. However, no method of transmission over the internet or method of electronic storage is 100% secure. By selecting yes,  you are consenting to the collection, processing and use of the information in accordance to this privacy notice. The information you have provided will be used for documentation of podcast impact and communication purposes. The information is collected and stored through Google. Google has its own Privacy Policy, which can be found here: https://policies.google.com/privacy.
How many times have you taken this survey? Please do not take it more than 3 times (and only once before listening to the podcast), thank you! *
How old are you?
Clear selection
With which gender do you identify?
With what race/ethnicity do you identify?
Do you currently live in Washtenaw County or the greater Ann Arbor area?
Clear selection
Do you identify with having symptoms of a mental illness? It does not have to be diagnosed.
Clear selection
Next
Clear form
Never submit passwords through Google Forms.
This form was created inside of University of Michigan. Report Abuse
Google Forms