Upstream Committee Wellness Check-In

Statement of Purpose

Having a variety of opportunities to interact with other people can help improve the quality of our lives. Feeling connected to others and having a sense of belonging can be tough, especially nowadays. Please complete this short survey to share your opinion about creative ways we can interact more with other people. Thank you!

If you are in need of support please contact Riverside County Help Line at 951-686- (HELP) 4357.

On a scale of 1-10 how satisfied are you with your own sense of connection to others?

1 (Not Satisfied)

5 (Somewhat Satisfied)

10 (Very Satisfied)

Do you feel a part of a larger community?

Yes

If you selected no, which of the following are true. (SELECT ALL THAT APPLY)

I do not feel alone

I lack companionship

I am no longer close to anyone

I feel a part of a small group of friends

I am unhappy being so withdrawn

I can't find companionship when I want it

Other (please specify)

Name some things or activites you do that have helped you to remain hopeful during this pandemic.

If you could share some advice with others on ways to increase their hope and gratitude during tough times, what would it be?

Would you like to speak or share with others such as the youth?

Yes

Not sure

Do you have any other comments, questions, or concerns? If so, share them below.

Age:

I am a family caregiver:

Yes

Optional:

Name

Email Address

Phone Number

Do we have permission to share your comments and answers anonymously?

Yes

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