SMILING FACES

G

O ING PLAC E S

Please answer the following questions as best you can.

1. In your own words, describe what you think mental health is?

2. Do you know about the resources available at the West Alabama Mental Health Center? [ ] Yes. Please tell us what you know_____________________________________ ________________________________________________________________ [ ] No

3. How did you find out about tonight’s event? [ ] I received a flier [ ] I heard about it on the radio [ ] I read about it in the newspaper [ ] Other __________________

Read the following story to answer questions 3 & 4

Jane Smith is a girl in 6th grade. She is very quiet and does not play with other children at recess. She usually sits by herself at lunch. Jane does not have many friends and doesnt hang out with many of the people in her class.

4. Compared to other children in her class, do you think Jane is- (check all that apply) [ ] Lazier [ ] More Violent [ ] Smarter [ ] More Troublesome [ ] None of the above

5. If Jane were your child, how would you feel? (check all that apply) [ ] Concerned [ ] Proud [ ] Confused [ ] Embarrassed [ ] Mad [ ] Other_______________

Thank you for your help in filling out this survey! Please include the following information for our records:Name _____________________ Check all that apply: Address ____________________ [ ] Please send me a free quarterly newsletter _____________________ [ ] Please add me to your email listEmail ______________________ [ ] Thank you, but I am not interested in further contact