BIPOC INDIVIDUAL SURVEY

Office of Racial Equity and Social Justice (ORESJ) - BIPOC Individual Survey

Please take a moment to complete this survey to the best of your ability. Your feedback will help shape and enhance our communication and community engagement efforts with Black, Indigenous, and other People of Color (BIPOC) living in the county. Survey Results will be kept confidential and used only for Montgomery County's internal purposes.

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* 1. How do you or your community receive information from Montgomery County government? (Please select all that apply)

Emails, E-Newsletters

Social media platforms (Facebook, X (ci-devant Twitter), Instagram, LinkedIn)

Advisory Groups, Committees, Board or Commissions

Community Forums, Townhalls,

Montgomery County’s Website

Local Newspapers

Public Service Announcement: flyers or posters in public spaces such as public library

Trusted community partners: faith-based, nonprofits,

N/A

Other (please specify)

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* 2. Do you have any preferred communication channel(s) that is more accessible to you? Please specify

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* 3. How would you or your community prefer to engage in two-way communication with the Montgomery County Government (MCG), where you can express concerns, provide and receive information? (Please select all that apply)

Townhall meetings

Virtual meetings (Interactive Webinars and Online Meetings)

Email correspondence

Small group setting in the community

Other (please specify)

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* 4. On a scale of 1 to 5, how well-informed are you about Montgomery County government initiatives, services, resources, or programs? (1 being not informed at all, 5 being very well-informed)

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* 5. How would you describe your racial or ethnic identity?

American Indian or Alaska Native

Asian or Asian American

Black or African American

Hispanic or Latino

Middle Eastern or North African

Native Hawaiian or other Pacific Islander

White

Other (Please specify)

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* 6. What is your gender identity? [Please select)

Male

Female

Gender Fluid

Nonbinary

Transgender

I prefer not to share at this time.

Other (please specify)

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* 7. Please select the age group you are affiliated with." (Please select)

Young Adults: 18-24 years:

Adults: 25-34 years:

Middle Adults: 35-49 years:

Older Adults: 50-64 years:

Seniors: 65 years and older

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* 8. Which of the following best describes how long you have lived in in Montgomery County (Please select)

New resident (less than 1 year)

Recent resident (1-3 years)

Mid-term resident (4-6 years)

Long-term resident (7-10 years)

Very long-term resident (more than 10 years)

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* 9. Is there anything else you want to share with us, about the best way to engage with you.

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* 10. Please share your information if you would like to be connected with county boards, commissions, or advisory boards.

Name

City/Town

ZIP/Postal Code

Email Address

Phone Number