Jail Diversion Survey Demographics Question Title * 1. Agency name: Question Title * 2. Which would you say most accurately describes your agency (check all that apply)? Corrections Judicial (e.g., Judges, Court Personnel, etc.) Law enforcement Legal (e.g., District Attorney, Public Defender, etc.) Local Government Unit (LGU) Local Mental Health Commissioner Medical provider (e.g., hospital, emergency medical services, urgent care) Mental health provider Probation/parole Substance use provider Other (please specify) Question Title * 3. Which county(ies) do you serve? (Check all that apply) Albany Alleghany Bronx Broome Cattaraugus Cayuga Chautauqua Chemung Chenango Clinton Columbia Cortland Delaware Dutchess Erie Essex Franklin Fulton Genesee Greene Hamilton Herkimer Jefferson Kings Lewis Livingston Madison Monroe Montgomery Nassau New York Niagara Oneida Onondaga Ontario Orange Orleans Oswego Otsego Putnam Queens Rensselaer Richmond Rockland Lawrence Saratoga Schenectady Schoharie Schuyler Seneca Steuben Suffolk Sullivan Tioga Tompkins Ulster Warren Washington Wayne Westchester Wyoming Yates Question Title * 4. Your name: Question Title * 5. Title: Question Title * 6. Email: Question Title * 7. Phone number (e.g. (555) 555-5555): Question Title * 8. How long have you been with your agency? (Please respond with a numerical value, e.g., 1, 2, 3) Years Months 3% of survey complete. Next
