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Philadelphia Violence Prevention Stakeholder Survey

Stakeholder Survey--Violence Prevention Pilot in Philadelphia

The City of Philadelphia is partnering with Heartland Alliance to plan and launch a new, innovative violence prevention pilot in a selected Philadelphia community, based on the lessons learned from Heartland’s READI Chicago initiative. The first phase of this project involves identifying and reaching out to stakeholders across the city who work in violence prevention or have lived experience of community violence. Please take a few minutes to complete this stakeholder survey and let us know about your role and what you think your community needs to effectively address gun violence. Please also forward this survey to anyone in your network who you think should respond. In the next phase of this work, we will be inviting selected stakeholders to participate in stakeholder feedback meetings to share our plans and gather feedback. Thank you!

1. What does your community need most in order to address gun violence?

2. Would you be interested in participating in a community stakeholder meeting to provide input on a new violence prevention pilot project in Philadelphia?

3. How supportive would you be of a violence prevention pilot in Philadelphia that combines intensive outreach, immediate income, a cognitive-behavioral intervention, and support services?

	Very supportive	Supportive	Neutral	Not supportive	Very unsupportive
Supportive	Very supportive	Supportive	Neutral	Not supportive	Very unsupportive	Unsupportive

4. Your organization

5. Your role

6. What Zip Code do you live in?

7. What Zip Code do you work in?

8. Do you or your organization work with individuals impacted by community violence?

9. What services do you or your organization offer to individuals impacted by community violence? (check all that apply)

9. What other individuals or organizations in your community should we reach out to? (please include names and contact information if possible)

10. Is there anything else you want to share with us?

Personal information: We would like to know about you, how to contact you, and some demographic information. These questions are optional--you may take the survey anonymously if you prefer.

11. Name

12. Address

13. Phone number

14. Email address

15. Which race(s) apply to you? Select all that apply.

American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or Other Pacific Islander
White
Don’t know
Don't want to respond
Other - Write In Please enter an 'other' value for this selection.

16. Which ethnicity applies to you?

Please enter an 'other' value for this selection.

17. How would you describe your gender identity?

Please enter an 'other' value for this selection.