Logo Page 1 of 8

Coalition Member Perception Survey 08/2016

Purpose of Research

The purpose of this survey is to assess coalition member perceptions regarding community collaboration and the prevention and reduction of youth substance use in the Town of Bennington, Vermont. 

Potential Benefits

The potential benefits of participating in this survey include, but are not limited to, influencing development of coalition 12-month action plan goals, evoking change in community collaboration practices, increasing coalition effectiveness and strengthening the coalition structure. 

Potential Risks

The few potential risks (e.g. potential for violation of privacy, stress from survey completion, legal requirement to disclose information) to participating in this survey are considered minimal, as survey questions will NOT ask for participants to report personal behaviors and no names or other identifiable information will be collected on completed surveys. 

Voluntary Participation

Your participation in this survey is completely voluntary.  You may decide not to participate at all or may decide to stop participation at any time.  If you have questions or concerns about this survey, if you want your rights as a survey participant explained to you or if you want to revoke your consent to participate in this survey, you may contact Kiah Morris, Director of the Alliance for Community Transformations, at 802-442-0713 or at kmorris@bcrcvt.org, at any time. 


The information provided on this survey will be kept confidential; confidentiality will be maintained to the degree permitted by the technology used.  Compliance with federal and state laws is mandatory and requires certain types of information to be reported to the appropriate agencies/individuals.

Time Required

This survey is expected to require approximately 10 minutes of your time to complete. 


By clicking NEXT, you affirm that you are aged 18 years of age or older, have read and understand the above information, acknowledge that your participation in this survey is completely voluntary and that you may choose not to participate in this survey at all or at any time, and grant your consent to participate in this survey, conducted for research purposes.