Webinar: Providing Cessation & Supportive Housing
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Participant Information

Please tell us a little bit about yourself.

1. First and Last Name

First and Last Name

2. Email Address

Email Address

3. Phone Number

Phone Number

4. Organization

Organization

5. Job Title

Job Title

6. Has your organization/community received any of the following grants? (check all that apply)

Has your organization/community received any of the following grants? (check all that apply) Communities Putting Prevention to Work (CPPW)

Community Transformation Grant (CTG)

Neither

7. Is your organization/community currently working on smoke-free multi-housing?

Is your organization/community currently working on smoke-free multi-housing? Yes

Not right now, but we plan to begin work in the next year