Sign In Assessment Arkansas First NameLast NameRelationship to Recovery Person in Substance Use Recovery Person in Mental Health Recovery Person in Substance Use and Mental Health Recovery Family Member Recovery Ally Person who uses drugs None Age 18-24 25-34 35-44 45-54 55-64 65+ Choose not to disclose Gender Male Female Other Choose not to disclose Race / Ethnicity Hispanic or Latino/a Black or African American American Indian or Alaska Native Asian Native Hawaiian or Other Pacific Islander Multiracial/Multiethnic Choose not to disclose Employment Full-time Part-time Contractor / Freelance Temporary / Seasonal Intern / Co-op Other Highest Level of Education No schooling completed Nursery school to 8th grade Some high school, no diploma High school graduate (or equivalent, e.g., GED) Some college credit, no degree Trade/technical/vocational training Associate degree Bachelor’s degree Master’s degree Professional degree Doctorate degree Do you identify as a person with a disability? No Yes – Vision Yes – Hearing Yes – Mobility Yes – Cognitive Yes – Mental health Yes – Chronic condition Yes – Substance use disorder Which best describes your role? (Select all that apply) Person in recovery Peer Specialist Peer Supervisor Recovery Community Organization staff Healthcare provider Behavioral health provider Clinician Policymaker / system leader Family member / support person Community partner Other Do you primarily work in: Suburban Urban Rural Frontier / highly rural Have you previously participated in a community-led recovery planning process? Yes No
