Tribal Opioid Response Community Perceptions Survey

The Rocky Mountain Tribal Leaders Council (RMTLC) Tribal Opioid Response (TOR) project is collecting information on the opioid crisis in the Rocky Mountain region. The results of this questionnaire will be put together to create prevention activities for opioid misuse. The questionnaire should take no more than 3-5 minutes to complete, and your responses will remain anonymous.

To be eligible you must be over 18 years old, self-identify as American Indian or Alaska Native, and reside in the States of Montana or Wyoming. Enter for a chance to win 1 of 10 gift cards (value: $10).

Question Title

* 1. What is your age (in years)?

Under 18

18-24

25-34

35-44

45-54

55-64

65+

Prefer not to answer

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* 2. Do you identify as American Indian/Alaska Native?

Yes

Prefer not to answer

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* 3. Do you reside in the States of Montana or Wyoming?

Yes

Tribal Opioid Response Community Perceptions Survey

Question Title

* 1. What is your age (in years)?

Question Title

* 2. Do you identify as American Indian/Alaska Native?

Question Title

* 3. Do you reside in the States of Montana or Wyoming?

Question Title

* 4. Please enter the name of the County and State in which you live: