CHAP Learning Collaborative Survey Question Title * 1. Demographics: What race do you identify as? 🞎 American Indian or Alaska Native 🞎 Asian or Pacific Islander 🞎 Black 🞎 White 🞎 Hispanic Question Title * 2. What gender do you identify with? 🞎 Male 🞎 Female 🞎 Nonbinary/two spirit 🞎 Prefer not to say Question Title * 3. What is your age range? 🞎 19-24 🞎 25-34 🞎 35-44 🞎 45-54 🞎 55-64 🞎 65 and above Question Title * 4. Do you live in the Pawnee Nation service jurisdiction (Pawnee, Payne, or Kay County)? 🞎 Yes No (If not, where do you live)? Question Title * 5. Do you work in the Pawnee Nation service jurisdiction (Pawnee, Payne, or Kay County)? 🞎 Yes 🞎 No Question Title * 6. In the last year, was there a time when you needed healthcare including medical care or dental care, but were not able to receive it? 🞎 Yes 🞎 No Next