The Community Advocacy program will engage a group of residents, community members and local businesses that have been marginalized in their communities. By leading with race we will educate and empower individuals and families on how to use their voice to create change in their community through policy, systems and environmental changes. This group will have a hyper focus on youth voices and barriers that are perpetuating the health disparities of Roxbury and Dorchester.

Barriers: The African American community and other marginalized groups in Boston feel unheard and unseen on issues that affect their mental, physical and overall health. We know that current systems can alienate these residents' voices and minimize opportunities for growth and healing. Additionally, many residents feel like frustrations are only heard during election season, with minimal to no accountability of elected officials and community organizers.

In order to address what the community has concerns about we need your voice by completing this form. Please feel free to contact me directly as well at tsamuel@madison-park.org or 774-360-0712 or info@thenubiansqaurefoundation.org

Respondent Information

First Name

Last Name

Zip Code

If you are responding to this survey as an individual, please list your home zip code. If you are responding on behalf of an organization or business, please list the organization's zip code.

Email Address

Phone Number

Are you a resident of a Madison Park Development Corporation property?

YesNoUnsure

Professional or Community Affiliation

If you are responding on behalf of an organization or business, please list the organization.

School, if applicable

Experiences in Your Community

Challenges & Barriers

If you selected "Other" in the previous question, please list here.

Please share your thoughts on the following statement:

	Not enough	About the right amount	Too often
"When I think about challenges and barriers in my community, I think these topics are discussed..."

A "stigma" is a set of negative and unfair beliefs that a society or group of people have about something. One example is openly discussing mental health struggles. Are there any stigmas in your community you think need to be broken?

Community Violence

	Not an important issue	A little important	Somewhat important	Very important	The most important issue
In your opinion, how important is the issue of violence in your community?

In your opinion, what contribute to violence in your community?

Your Community & the Environment

	Not an important issue	A little important	Somewhat important	Very important	The most important issue
In your opinion, how important is the topic of environmental justice (i.e. having access to a clean, healthy environment regardless of a community's racial makeup or wealth level) to your community?

School & Education*

*NOTE: This section is only applicable to people currently in school or the parents/guardians of students. Please skip to the next section if if does not apply to you.

	Not an important issue	A little important	Somewhat important	Very important	The most important issue
In your opinion, how important is the issue of improving access to high quality education in your community?

If you were to change something in your school, or your child’s school, what would you change? Why?

Mental Health AwarenessSecondary Education SupportGreater Promotion of/Access to TradeschoolsImproved IEP or 504 Plan ProcessAddressing abuses of power

For Current Students: Do you feel you have ever been unfairly disciplined at school because of your race/ethnicity?

YesNoUnsure

Your Priorities for the Community

Mental health is something that can be affected by unfair social and economic conditions, like poverty, lack of access to health care or poor quality education. To what degree would you say your mental health is impacted by these types of factors in your environment?

Not at allA littleA great dealNot applicable

If you selected "Other'" please specify.

Please share any additional thoughts about why you selected the answers you did in the previous question.

Policy & Civic Engagement

The purpose of this section is to learn more about your familiarity with civic processes and elected officials in your community.

	Yes	No
I know who my district Boston City Councilor is.
I know who my Mayor is.
I know who my Massachusetts State Representative is.
I know what my voting district is.
I know where my polling (voting) location is.
I understand the public funding process for how services in my community get funded.
I am registered to vote.

If not registed to vote, why?

Are there topics you think are not discussed enough in your community, school and/or with elected officials? If so, please share what those topics are. Some examples might be use of drugs, access to weapons, mental health, reliable transportation, etc.

If you could change one existing policy (i.e. housing, criminal justice, education, voting processes, transportation, etc), what would you change? Why?

If you selected other, please share more information here.

If you had the chance to bring up any questions regarding the issues you face in your community to a local elected official, what would you ask?

If you could speak one-on-one with the Mayor of Boston, what would you say or ask for?

More About You

We are hoping to learn more about you and your life experiences in this section. This section is completely optional and you do not have to answer anything that makes you feel uncomfortable.

	Yes	No	Unsure	Choose not to answer
Is there a building or place in your community where you can safely gather without fear of discrimination?
Do you have someone you can contact if you experienced a medical emergency?
Do you have someone you can contact if you experienced a medical emergency?
Is there a supermarket or store that is accessible to you where you can get affordable, fresh produce?

Do you suffer from health conditions (mental or physical) that impact your ability to get through your day?

YesNoChoose not to answer

If you answered "Yes" to the question above, are you receiving any care/support for those conditions? If not, what are the barriers preventing you from getting that care/support?

Involvement in Your Community

	Not at all	A little involved	Somewhat involved	Very involved	Choose not to answer
How involved would you say you are in serving your community?

What is one thing you would do to create change or make your voice to be heard in your community?

What is the best way for you to get you involved in what is going on in your community? This could include joining a neighborhood group, doing voter outreach, educating yourself about local policies, volunteering, etc.

Would you like to learn more about ways to get involved in your community?

Yes please!No thank you.

Last Questions!

Do you enjoy art? This can include music, television, movies, visual art like paintings or sculptures, design and architecture, performances, etc?

YesNoSometimes; it depends on the type

Contact Information