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SacMap Provider Workshop Registration - September 28, 2021

REGISTRANT INFORMATION
DEMOGRAPHIC QUESTIONS

To be eligible to receive a $25.00 participant stipend, you must complete the demographic survey, and follow-up post-evaluation that will be available to you after completing the workshop.

What is this survey all about?

The Sacramento County Division of Behavioral Health, which funds the SacMap program wants to measure our ability to serve diverse populations throughout California. Most of the questions on this page are optional, but we hope you will complete them all.
 
Please select your current age group.
 
This question requires a valid date format of MM/DD/YYYY.
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Not everyone uses the same labels, however, please indicate your sex?
 
Not everyone uses the same labels, however, which BEST describes your current gender?
 
Not everyone uses the same labels to describe their sexual orientation, however, which BEST describes your sexual orientation?
 
Please indicate your ethnicity.
 
Please select your race.
Please select your primary language.
 
Please identify if you are a consumer and/or family member:
Are you a military veteran?
 
Do you identify as a current or former member of any of the groups listed below? (check all that apply)
Have questions?  Need help?

Email us at sacmap@calvoices.org and we can walk you through it!